Quality Account 2015 -16 - NHS...Quality Account 2015 -16 Teesside Hospice 1, Northgate Road, Linthorpe, Middlesbrough, TS5 5NW Registered Charity Number - 512875 “Thank you.I don't

Quality Account

2015 -16

Teesside Hospice

1, Northgate Road, Linthorpe, Middlesbrough,

TS5 5NW Registered Charity Number - 512875

“Thank you. I don't know where to start/finish. Hospice is a lovely place and staffed by amazing people who clearly love what they do (from cleaners to doctors). I felt very safe and cared for immediately. Fantastic.”

Mission Statement

Teesside Hospice Care Foundation (THCF) is committed to enhancing the quality of life of those suffering from life limiting illness, offering specialist palliative care

and support to patients and their carers in the belief that each person is entitled to dignity and choice within the best provision of care.

2

Patient comment – Inpatient Unit Satisfaction Survey ““I’m so grateful of being a part of the hospice, the support I have amazing and the friendship between staff support unreal. Love meeting new people and making friends all the way through my journey in the hospice. Couldn’t thank all the staff enough 100% hardworking staff.” Patient comment – Day Hospice Satisfaction Survey “It is the one place I feel people really care about your feelings and how you are coping with both pain and emotionally.” Patient comment – Day Hospice Satisfaction Survey

“Politeness and caring nature of staff. They come across like they cared and wanted to help and I wasn’t judged for having this condition.” Patient comment – Community Lymphoedema Satisfaction Survey The best thing about Teesside hospice was:- “Dad felt he had personal attention almost on one to one basis. He felt considered as special – which he was – and respected. From Day care to residential Dad developed faith and trust in the hospice care and was treated with dignity till the end”

Bereaved Carer 2015 “My son received the best care imaginable, it felt like his home, the hospice and every single member of staff from cleaners, catering, nursing, doctors, social worker etc! made him, myself and the rest of the family feel so welcome and comfortable, and gave him the best quality of care in his last few weeks and helped us enjoy and * his last remaining days, cannot thank you all enough.”

Bereaved Carer 2015 “We can never thank you enough for the outstanding care you gave to mam. She was treated with care and dignity intact, nothing was too much trouble. The love, warmth and humour of your staff was so appreciated by mam and all the family. She had a peaceful, painless death and our grieving process has been made easier to accept knowing that she left us in such a wonderful place”. Bereaved Carer 2015

3

PART 1 Statement from Chief Executive Teesside Hospice Care Foundation is committed to delivering the best possible experience for patients and their families. Through the Hospice’s Consultant led multi professional team we aim to provide the highest standard of specialist palliative care we can achieve. We are committed to continuous improvement within the Specialist Palliative Care we deliver. This Quality Account will hopefully demonstrate the level of commitment we have to deliver, review and improve the quality of the service we provide to patients and their families that access our services. We rely on the feedback from patients and families who use our services. The Care Quality Commission made an unannounced inspection to the Hospice in March 2016, the outcome is awaited at the time of this report publication. The Board of Trustees continues to oversee the corporate governance of the organisation, with various sub committees having Trustee representation. We have benefited from recruiting two new trustees who between them bring a vast amount of professional knowledge and experience. Throughout the year the Board of Trustees and the Senior Management Team have worked on the Clinical Strategy framework for the hospice, this stream of work has resulted in the development of the Hospices’ 2020 vision and clear strategic objectives. The board has agreed investment into clinical development which will shape the service for the future. Policy review and new documentation is developed with the inclusion of the appropriate management and staff. We receive 32% funding from the NHS but rely heavily on our Trading Company together with the very generous support of local businesses and supporters to make up the remaining 68% of the required funding. Legacy income is not a guaranteed source of income but is needed to ensure the Hospice has vital reserves going forward. Teesside Hospice is a local Charity based in Middlesbrough. Throughout 2015/16 the Hospice has continued to ensure strong financial stability. I would like to thank all staff, volunteers and supporters for their dedication in contributing to make our patients and families have the best experience of palliative care we can deliver. To the best of my knowledge the details within these accounts reflects an accurate and a fair representation of the quality of care provided by Teesside Hospice. Maureen Thompson Chief Executive

4

PART 2 Looking ahead: Key priorities for improvement for 2015/16 2.1 Introduction Teesside Hospice Care Foundation (THCF) was established in 1982 as a specialist palliative care centre to enhance the quality of life of those suffering from life limiting illnesses. It offers Consultant led specialist palliative care and support to patients and their carers.

Our aim is to provide the relief of complex symptoms with regard to physical, social, psychological and spiritual aspects of patient/family care, thus enabling them to return home or to another care environment. The majority of care to patients, families and carers focuses upon pain and symptom control and end of life care. An annual patient survey is

undertaken and managed by THCF Clinical Audit Group. The outcome of the survey is shared with the Clinical Governance Committee, Council of Management Trustees and summaries of the survey are displayed as posters in each department to inform patients, their families and other visitors to the organisation of the outcome of the survey. A carer support programme is established alongside the Day Hospice service and where possible patient and carer views are sought prior to specific changes or service developments.

In March 2016, Teesside Hospice received an unannounced inspection by the Care Quality Commission (CQC) following the submission of our Provider Information Return (PIR). Our immediate feedback was extremely positive but we are currently awaiting the full report and grading of our service. Teesside Hospice monitors the quality of care that is provided across the organisation via its Clinical Governance Committee. The importance of providing quality care is underlined by the membership of the committee which includes the organisation’s most senior clinicians, the Director of Patient Services and representatives from the Board of Trustees. The Hospice’s catchment area is predominately Middlesbrough, Redcar and Cleveland areas however, we are also contracted to provide a Tees wide specialist community lymphoedema service.

5

2.2 Improvement Aspirations Aspiration 1 - Patient Safety Why choose this priority? Non medical prescribers are healthcare professionals other than doctors, who are able to prescribe medication. Non medical prescribers can be registered nurses, pharmacists or radiographers who undergo appropriate training in order to be competent to prescribe in their area of clinical expertise. Research has shown that non medical prescribing has improved quality of service to patients, is convenient and has demonstrated improved outcomes. At Teesside Hospice we employ 3 senior members of nursing staff who have a non-medical prescribing qualification in the Palliative Care setting. The organisation is keen to develop their role to enhance the quality of care provided to patients. This may mean patients receiving appropriate medication by clinical staff who are better placed to identify the patient’s needs more promptly.

How will this priority be achieved? Initially we will form a small task group which will include the nursing staff with the non medical prescribing qualifications, senior medical staff, pharmacist and Clinical Team Leader. This group will explore where non medical prescribing can be used in order to benefit patients and ensure patient safety. This will include supervision and support for the non medical prescribers and job competency framework for this particular clinical role.

How will this priority be measured?

- Non-prescribers will complete a learning log and evaluate their experience with reflection after 6 month pilot.

- Questionnaire for all nursing staff and medical staff to complete following the pilot seeking feedback

Develop the Role of Non-Medical Prescribing at Teesside Hospice

6

Aspiration 2 – Clinical Effectiveness

Why choose this priority? Why choose this priority? Problems surrounding the adequate and timely communication of essential information to primary and social care services at the time a patient is discharged from health care settings has been identified as a particular risk to patient safety. NHS England is leading a national programme of work to support organisations in improving the communication and management of information when patients are discharged by building on successful local and national initiatives already in place. At Teesside Hospice we believe the successful discharge of patients following a period of time spent here relies on effective joint working between the patient and their families, community services, social care partners and all services involved in the ongoing care of the patient. The aim is to anticipate and promptly respond to potential problems, and ensure a smooth and safe patient discharge whilst regular patient and carer feedback is sought about discharge arrangements to ensure common understanding and agreement.

How will this be achieved?

Standard templates have been produced on SystmOne including all discharge information required by community professionals that will be involved.

The group will further develop a discharge pack to include information that will support the patient and

family on discharge.

The group have agreed that a discharge information board will be placed in the briefing room to aid communication around complex discharges.

All changes will be shared with community teams/professionals

The group will work on an audit tool to measure the efficiency of the new discharge process.

How will this be measured?

All members of staff have been asked for feedback and will be given a questionnaire regarding the new process.

We will include a questionnaire for patients, families and professional partners asking for feedback regarding the discharge process.

Complaints and incident forms will be reviewed quarterly

Ongoing evaluation and review will be undertaken and cascaded to staff at regular meetings.

Discharge Profile

7

Aspiration 3 – Patient Experience Why choose this priority? “Hospices should do more to value and support carers as partners and beneficiaries of support. Support and help for carers should be more extensive, providing them with the aid they need to do their job better whilst retaining their relationships with those they are caring for” (Hospice UK, Future needs and preferences for hospice care: challenges and opportunities for hospices, 2013). How will this be achieved? The Carer Support group at Teesside Hospice has historically been run twice per year. It consists of a six week programme of support co-ordinated by the hospice social worker. The sessions are supported by many of the professionals within the Hospice multi-disciplinary team (MDT); nurses, doctors, social worker, dietician, occupational therapist, physiotherapist, counsellor and the complementary therapy team. Carers of patients from the Day Hospice and IPU are invited to attend and we also accept referrals from the community Macmillan Team. The programme is evaluated after the final session and each session is rated on a scale of 1-10, with an opportunity to provide a comment about each session. There are also two qualitative questions included which ask ‘what did you find most useful?’ and ‘what could have been better?’ Consent from the carer is gained to include this information in future audits and research within the hospice to enable us to continually improve.

A selection of comments highlight that the carers clearly benefit from attending the group sessions: “It was a relief to meet people who knew what we are going through” “It was a reminder of the diet needs of people – taste session was very good” “I got good tips from other cares” “Good to find out what’s available to aid patients when simple tasks become difficult” “I got a lot of information and able to ask sensitive questions” “It was useful to know that feelings count and able to share real experiences” “Good to know I’m not on my own and people can help me” “A relaxing end to the sessions, a lovely massage thank you”

Reflecting on the statements received from the qualitative questions it is evident that carers benefit greatly from meeting each other and the support gained from this is invaluable;

Increase support for carers

8

“Meeting other people in the same situation as me good to know I’m not on my own” “Everything, Found some great friends and all the staff are understanding” “Meeting other in similar situations – a chance to talk” “Meeting other people – and discussing their worries, helped me a lot” “All sessions were useful to me” “Not stopping! Have regular meetings for carers to have a cuppa and a talk or just time out” As a result of these comments, the hospice has now developed links with ‘Carers Together’ – the local organisation involved in carer support within Middlesbrough and Redcar & Cleveland. The Chief Executive of Carers Together has agreed to attend the final session of future programmes to ensure ongoing support is available to carers. The Hospice has also gained funding from the Board of Trustees to extend the number of carers groups from two to four per year. We are also responding to the growing demand for Day Hospice services in relation to patients suffering neurological conditions. In view of this, we have liaised with specialist nurses representing patients with Motor Neurone disease and Parkinson’s disease to discuss offering carer support. A pilot group is planned to start in July 2016 and the Hospice team will work closely with the specialist teams involved to extend carer support in this area. How will this be measured? The Carers Group will continue to be evaluated. As in previous years, the results are collated and presented to the Audit Group with an agreed action plan. Additional feedback will be sought from the specialist teams in relation to the pilot group for carers of patients with neurological conditions. If this is successful, the group may be offered twice yearly. The Hospice will continue to collaborate with Carers Together to sustain a strong partnership in order to sustain carer support to those involved in caring for patients with palliative conditions. 2.3 Statements of Assurance from the Board - (Formal statements required by the Department of Health) The following are statements under various headings that all providers of NHS healthcare services must include in their Quality Account, even though many of the statements are not directly applicable to Teesside Hospice.

a. Review of Services During the reporting period 2015/16 Teesside Hospice provided the following Specialist Palliative Care Services to the NHS:

• Inpatient Unit – 10 beds

• Day Hospice Services

• Specialist Community Lymphoedema Services

• Medical Out Patient Services

• Adult and Children’s Bereavement Counselling Service

9

Teesside Hospice has reviewed all the data available to us in terms of the quality of care delivered. Activity data is provided to the Commissioners of these services on a quarterly basis and is reviewed at quarterly meetings with the Commissioner, Chief Executive (CE) and Director of Patient Services (DPS).

The income generated by the NHS services reviewed by this quality account represents 32% of the total income generated from the provision of NHS services by Teesside Hospice for 2015/16. This 32% represents only part of the funding required to provide services at Teesside Hospice. The remaining 68% of income is generated through fundraising, charity shops income, lottery activity and investment income and we are dependent on the generosity of the local community in sustaining this income. The NHS contract means that all services delivered by Teesside Hospice are partly funded by the NHS and partly funded from charitable funds.

b. Participation in Clinical Audit

During 2015/16, there were no national clinical audits and no national confidential enquiries covering NHS services relating to palliative care. Therefore, during that period Teesside Hospice was not eligible to participate in any national clinical audits and national confidential enquiries.

c. Research

The number of patients receiving NHS services provided by Teesside Hospice in 2015/16 that were recruited during that period to participate in research approved by a research ethics committee was ZERO. There was no appropriate, national, ethically approved research studies in palliative care in which we could participate.

d. Commissioning for Quality and Innovation (CQuIN) Payment Framework

A proportion of Teesside Hospice’s NHS income in 2015/16 was conditional on achieving quality improvement and innovation goals agreed between Teesside Hospice and the commissioning CCG. The improvement conditions that were agreed were:

• NHS Safety Thermometer - collecting data and demonstrating a reduction in the incidence of pressure ulcers, falls and urinary infection in patients with a catheter

• Undertaking a local patient experience survey and implementing actions resulting from the survey and including Friends and Family Test in the survey.

The two CQuIN measures represent 2.5% of the overall contract value with both being successfully achieved with full payment.

e. The Care Quality Commission

Teesside Hospice is required to register with the Care Quality Commission and its current registration status is for the following regulated activities:

• Treatment of disease, disorder or injury

10

• Diagnostic and screening procedures

• Transport services, triage and medical advice provided remotely

Teesside Hospice is registered with the following conditions: • Services are provided for people over 18 years old • The maximum of 10 patients may be accommodated overnight • Notification in writing must be provided to the Care Quality Commission at

least one month prior to providing treatment or services not detailed in the Statement of Purpose

The last unannounced routine inspection of Teesside Hospice took place on 16th March 2016. Our immediate feedback was extremely positive but we are currently awaiting the full report and grading of our service.

f. Data Quality

Teesside Hospice did not submit records during 2015/16 to the Secondary Users service for inclusion in the Hospital Episode Statistics which are included in the latest published data. Teesside Hospice is not eligible to participate in the scheme.

g. Information Governance Toolkit attainment levels

Teesside Hospice has an information sharing agreement with South Tees NHS Trust, whereby we have a remote access provision to patient IT systems. We also store patient information on our own network. All organisations that have either direct or indirect access to Health and Social Care Information Centre (HSCIC) Services must complete an annual Information Governance Toolkit Assessment.

h. Clinical Coding Error Rate

Teesside Hospice was not subject to the ‘Payment by Results’ clinical coding audit by the Audit Commission during 2015/16. It is in a self-assessment format. We have successfully submitted our voluntary sector organisation self-assessment for 2015/16 achieving a pass level 2 on all applicable requirements. We have developed a completion plan for next year which aims to move to level 3 (maximum score) where feasible.

11

Part 3 Review of Quality Performance The quality improvements outlined in the 2014/15 Quality Account have all been satisfactorily achieved and in all areas continuous improvement is planned. The Board of Trustees has been in full support of the improvement areas over the past year and has received regular reports on progress. Services users have been consulted with where appropriate.

3.1 Improvement Priority 1 (Patient Safety)

To improve the quality of the patient hand over process on the Inpatient Unit. The primary purpose of nurse handover is clearly the exchange of information from the outgoing nurses to the incoming nurses to enable the latter to nurse appropriately. However, due to the demands of a specialist palliative unit handover also serves as a supportive function for nurses. The importance of a new structured handover tool in order to improve communication between all members of the multidisciplinary team and maintain patient safety, and continuity of patient care will bring about improvements in the specialist unit. The NHS institute for innovation and improvement suggests using the SBAR tool to improve clinical communication during handover. It comprises of: S- Situation, B- Background, A- Assessment, and R- Recommendations, this provides a structured way of showing the patients journey. The general principle of a handover should be the history of the patient, the care pathway right up to discharge, where they are on that care pathway, and what part of that pathway should be completed on the next shift. A selection of staff formed a steering group to look at the effectiveness of our verbal handovers between shifts. We used a questionnaire and observation to establish and highlight any changes required. The group began to develop a written format which would aid the nurse to ensure effectiveness and clarity of information and communication. However, the introduction of the documentation is on hold due to the introduction of SystmOne. A template is being developed that incorporates all aspects of the SBAR tool and will be piloting for 3 months from June 2016. However, the improved communication through handover is a priority with information shared between staff and senior members of the nursing team. There has been a noticeable improvement with all members of the MDT being encouraged to be part of the nursing handover. We have also looked at supporting the staff in the form of clinical supervision and introduced a more robust system of emotional and professional support. The handover still allows for ongoing support and staff are encouraged to discuss any issues openly as any problems arise. A leaflet has been developed advising staff on the support available alongside one to one clinical supervision groups or drop in support for all staff working within the hospice.

12

3.2 Improvement Priority 2 (Clinical Effectiveness)

To ensure that End of Life Care provided to patients at Teesside Hospice is patient centred, high quality and in accordance with the review of end of life care, ‘One Chance to get it Right’. End of life care is a significant part of the care that we provide at Teesside Hospice, with 48.6% of inpatient stays ending in death. After the Liverpool Care Pathway was phased out nationally in 2014, Teesside Hospice developed a new patient centred, individualised care plan (Assessment, Care and Treatment in the last days of life – ACT) to support the care of patients who we recognised may die within the next few days or hours. The introduction of this new care plan was supported by education for hospice staff, focussing on end of life care. The ACT document was initially piloted and has now been audited twice since its introduction. The audit tool used was based on the five priorities of care identified by the Leadership Alliance for Care of Dying People; Recognition, Communication, Shared decision making, Exploring others needs and Individualisation. Each cycle of the audit shows further improvement on an already excellent performance. Overall the audit re-affirms the high standard of care provision at Teesside Hospice and shows an excellent compliance with the five priority areas for care of the dying person. The audit also demonstrated areas for potential further improvement in the future including: increased multi-professional completion of the ACT document; offering all relatives written information regarding the dying process and care provided; review of documentation of nursing care plans and spiritual assessment and care in hospice notes. Since the last audit Teesside Hospice has moved from a paper to a computer based case record and it is hoped that this will facilitate improved multi-professional care and communication in end of life care.

In addition to completing the audit, feedback was gathered from a range of hospice staff regarding end of life care and the documentation of this. This was very positive, with end of life care being described as ‘exceptional’ and ‘outstanding’. There was a recognition that care provided was patient-centred and individualised and that time spent supporting carers emotionally helped them to cope at the time and was valuable for their subsequent bereavement.

At Teesside Hospice the quality of end of life care is also monitored through an annual Bereaved Carers Questionnaire. This supports the findings from the audit and staff feedback regarding the high standards of end of life care. We plan to continue this questionnaire and repeat the end of life audit in the future to support the continued improvement of the care we provide at Teesside Hospice.

13

3.3 Improvement Priority 3 (Patient Experience) Increase the social interaction of Inpatient Unit and Day Hospice patients and families. Improving the standard of care for patients and their families is a priority for Teesside Hospice and one way we do this is through listening to their feedback. As a result of feedback Teesside Hospice included an extension to the Inpatient Unit in the recent capital build program which was part funded from the Department of Health. This was to build a new family room for patients and families with bathroom, kitchen and dining facilities. The aim of this room was to:-

Increase social interaction between patients and also between families.

Avoid social isolation of patients who are cared for in single rooms.

Create an area where families can spend time together.

Encourage socialisation between Day Hospice and Inpatient Unit patients.

All of these aims have been achieved to some extent over the year. Families use the Rowan room on a daily basis and 100% of IPU staff questioned stated the Rowan room provides an excellent environment where families can spend time together. It has also become a wonderful place for families and patients to spend time together outside of their own room and has been used for numerous celebrations including birthdays, family movie nights, anniversaries and even a wedding reception. One staff member stated “this is providing a space for families and their loved ones to spend time together in a nice relaxing setting. Patients do use this alone either doing jigsaws, reading or watching TV.” The Rowan room has also become the perfect place for different patients and families to mix together. A relative of a IPU patient quoted “The room is very beneficial to me if my daughter is asleep I go in and have a cup of tea, read a paper or have a go at the jigsaw….what a lovely room it is …for relatives its excellent cos they speak to other relatives when making a drink.” Patients now are more likely to eat outside of their room if they are well enough and share meals and morning coffee and cake in the dining area of the room.

It has also been used for joint events for all patients and families, these include a Christmas carol service, a pantomime and watching sporting events such as the Grand National and football matches. On one occasion a fundraising event allowed the Hospice to purchase a TV facility to pay for a Middlesbrough football match to be watched. The room was decorated, and a cake was made and many patients and their families used the room to watch the match together. There has been some interaction

between the Day Hospice and Inpatient Unit patients but this area is still one that needs further development. There has been a few occasions when this has been

14

encouraged such as a flower arranging session’s, exercises groups and a presentation by a Day Hospice patient about a high speed blender she finds helpful to ensure adequate nutritional intake. All these sessions are open to both IPU & Day Hospice patients. One very successful use of the room was a User Forum which had previously been held in The Day Hospice. However, using the Rowan room enabled and encouraged IPU patients to attend as well which resulting in a very productive forum. During this User Forum, patients expressed how useful they found the room for them to spend time outside their own room to socialise with other guests or spend time with their family.

3.4 2014/15 Performance

a. What patients and families say about the services they receive We value the feedback we receive from patients and families as an important aspect of how we can identify issues, resolve problems and improve the quality of the care Teesside Hospice provides. As part of our commitment to ensuring patients and families have a voice we ask all appropriate patients from the Inpatient Unit to complete a patient satisfaction questionnaire and we also send a survey to the family of patients who die in our care. A patient survey is also given to all Day Hospice and Lymphoedema Service patients. The results of these surveys are collated and shared with Trustees, staff, volunteers, patients and carers by a yearly report on the survey findings published on the Teesside Hospice website and PowerPoint, or poster presentations. Although surveys are completed anonymously where concerns are raised and people identify themselves this is followed up on receipt of the completed questionnaire to resolve the issue and to learn from what has gone wrong. The Bereavement Counselling service gives all clients an evaluation sheet and an annual report was produced in May 2015. Following feedback the discharge process has been reviewed to ensure the evaluation forms are sent out timelier, the evaluation form has been reviewed and a collection box for the evaluations is now in waiting room. The lymphoedema team have distributed questionnaires to patients following their appointments and this was reported in 2015. This has resulted in higher chairs being placed in the waiting area, a diagram of the lymphatic system is now placed in the patient information pack and a support group has been set up for patients with Lipodema. The In Patient (IPU) Patients Satisfaction Survey - Summary of Results The annual IPU Satisfaction Survey from April 2015 – Dec 2015 had a response rate of 94% (58 returned out of 62 distributed). There were 139 patients admitted to IPU during this time therefore 42% of these patients fed back their views and 45% were given the questionnaire. However, there are a large number of patients that it is not appropriate to ask; who decline to complete the survey or who may have completed the questionnaire in a previous admission or as a Day Hospice patient. Some of the key findings from this report were:

15

100% patients stated they were always treated with respect.

100% patients stated staff always explained what they were doing prior to any procedure.

100% patients stated their care, treatment and support needs had been fully met.

100% patients stated they would recommend this service to a member of their family or friends.

100% patients felt their privacy was always or most of the time respected.

100% patients were always or most of the time satisfied with the response when they needed to ask for assistance.

100% patients felt supported in making decisions about their care either always or most of the time.

100% patients felt very satisfied or satisfied with their involvement in planning their care.

100% patients stated staff introduced themselves either always or most of the time.

100% patients stated staff always or most of the time made an effort to meet their individual wishes.

100% patients rated helpfulness of volunteers as either excellent or good.

100% patients rated standard of Nursing Care, Medical Care, emotional support, Occupational Therapy, Physiotherapy, Dietician, Chaplaincy / spiritual care, Complimentary Therapies, Counselling sessions, Hairdressing, cleanliness of the hospice, general environment and surroundings and room furnishings / comfort as either excellent or good.

Patients are invited to comment on anything they were particularly happy with or unhappy with giving an example if possible. A selection of responses are included below:

“The staff here were extremely helpful and couldn't do enough for me. They were cheerful and I was made to feel at home. If I was upset they were there to comfort me I was well supported by them and I really can't fault them at all.”

“All the staff were very helpful and I leave the Hospice feeling 100% better than when I arrived.” “I wouldn’t change any of the staff they are all lovely/, not just with residents but with my family members too. And the building and food are lovely.“ “I am particularly happy with every aspect of my care at Teesside Hospice I cannot express how grateful I am for all your outstanding care.”

16

“I don't think there is anything you can improve upon. You are a very caring profession of people. I have experience in both care you gave to me when my husband was here in his care and my own. I don't think there is anything more you could do to help people in your care” “I loved it here, home from home, me and my family are so happy how I've been treated and cared for, and cannot praise the staff enough for it, none of us have ever come across such nice caring people and can't thank them enough.” “It takes a long time for hearing aids to switch on, notice for treatment should be allowed.” “More crafts available on IPU instead of having to go to Day Care. 3 patients would have liked to join in crafts if they had been available.” “Staff and facilities always excellent, friendly and helpful, always ready to listen and as a family we feel fully involved in care and decisions made.” The Day Hospice Patient Satisfaction Survey – Summary of Results The survey was undertaken from April 2015 – December 2015 and had a response rate of 95% (39 returned out of 41 distributed). There were 112 patients who have attended the Day Hospice for 6 weeks or more during this time and should have been given the opportunity to fill out a satisfaction survey. Therefore, 35% of these patients fed back their views and 37% were given the questionnaire. However, there are a large number of patients that decline to complete the questionnaire and this has not been accounted for. Some of the key findings from this report are:-

100% patients stated they were always treated with respect.

100% patients felt their care, treatment and support needs have been met during their attendance to Day hospice.

100% patients felt their privacy was always or most of the time respected.

100% patients stated staff involved in their care always or most of the time introduced themselves.

100% patients stated staff always or most of the time made an effort to meet their individual wishes.

100% patients stated they had opportunities to ask questions about their care either always or most of the time.

100% patients felt the general environment and surroundings were either excellent or good.

100% patients felt supported either always or most of the time in making decisions about their care.

100% patients felt the staff made an effort to meet their individual needs and wishes nearly always of most of the time.

100% patients felt they always or most of the time understood explanations given to them regarding their treatment and care.

17

100% patients stated staff always or most of the time explained what they were doing prior to any procedure.

100% patients rated helpfulness of volunteers as either excellent or good.

100% patients rated standard of Nursing Care, Medical Care, Social Worker, Dietician, Complementary Therapies, counseling sessions, general environment and surroundings, cleanliness of the hospice and punctuality of hospice drivers as either excellent or good.

Patients are invited to comment on anything they were particularly happy with or unhappy with giving an example if possible. A selection of responses are included below:

“I found the whole service excellent. The support and encouragement received is

outstanding. I have particularly benefited from Acupuncture, Counselling,

Physiotherapy, and Complementary Therapy.”

“Just everyone is very caring and have

time to listen to you.”

“Staff are brilliant”

“Enjoyed coming into a small area –

did not feel overwhelmed by others.

The experience has been a lot better

that I expected.”

“The care and follow up on problems

that arise, the staff pursuing issues

until they find the answers if they can, I find this very satisfying.”

“I have no complaints or concerns about this Hospice whatsoever. I feel happy and

privileged to attend. Thank you.

“The staff are very friendly and helpful, could do with more activities to keep us

occupied.”

“I found the staff were all very welcoming and there was nothing too much trouble. I

felt that everything was done with caring and love.”

The Bereaved Carers Survey- Summary of Results The annual Bereaved Carers survey from (Jan 2015 – Dec 2015) had a response rate 49% (37 out of 75 sent out to carers). From previous research, bereaved carers were found to be the most open to providing feedback on hospice facilities and services. Therefore, a questionnaire was devised with user involvement as a way of evaluating services and increasing levels of user involvement in the future. Questionnaires are posted out 8 weeks following the death of the patient – this was

18

the advisory period given by members of the focus group. Some of the key findings from this report are:-

100% bereaved carers stated they would definitely recommend this service to a member of their family or friends.

100% bereaved carers rated standard of Nursing Care, Medical care, emotional support, Dietetic Support, Chaplaincy/Spiritual Care, Complimentary Therapies, Hairdressing, the catering team and room cleaning as either excellent or good.

100% bereaved carers rated helpfulness of reception staff and volunteers as either excellent or good.

Those completing the survey were also asked “What was the best thing about Teesside Hospice” and “Have you any thoughts that might help other patients and families using the hospice in the future?” Numerous comments were received and a selection are detailed below. “As a family our experience of the care provided by all who came into contact with * was absolutely first class and extended to us (particularly myself) was (and still is in my case) excellent. * felt his pain was much better controlled with you and he was much more comfortable & felt safer & reassured with you. Thank You!” “You don’t have to improve the service it is brilliant as it is so friendly and caring people. I have never met people like that before in my life”. “I cannot fault anything to do with Teesside Hospice. The staff were brilliant, friendly, caring and very professional”. “You don't need any suggestions it is a wonderful place and the staff, everybody involved with the hospice couldn't be better”.

“My husband could not have had the best of care anywhere else, he loved it in the hospice. It made him feel better and it made us feel better, his family we felt so much better when he went into the hospice”. “My time with my husband there was very helpful, it learnt me to slowly at the end to accept that I was going to lose *, he thought it was a great place”. “When a patient is admitted there is a lot of information to take in at a difficult time. I was initially unsure of what my and other visitor options were with regard to ordering and paying for a meal when at the hospice. It may be helpful for visitors to have some clearer information especially around the excellent coffee shop.” “Parking sometimes a problem but otherwise excellent”. “Excellent service and support from a fantastic team of people.”

19

“Everything about it, the rooms 5*, food 5*, gardens 5*, staff 5*. How you all wear a smile is beyond me, not enough words of thanks from my family and myself”. “All round excellent you treat my wife like a queen! God bless you!!” x “In retrospect I wish my wife could have been admitted earlier to the Hospice system. Would a home visit by one of the social workers be an option to explain what the Hospice can offer”.

Key projects / outcomes

In the last 12 months the Clinical Governance Committee (CGC) and its sub groups

have been actively working on a number of projects and initiatives. These include:

Assisted Dying Bill – Teesside Hospice position

This is a Bill to enable competent adults who are terminally ill to choose to be provided with medically supervised assistance to end their own life. In 2014/15 there was a great deal of debate nationally and within the Specialist Palliative Care community regarding assisted dying. A number of surveys were carried out and the Scottish Hospices declared themselves to be against assisted dying. In the rest of the UK only 27% of those who responded had an official stance. All Hospice’s were encouraged to develop an official response by Hospice UK. The CGC debated this issue and it was decided that we should prepare our response before the House of Lords debate took place in June 2015. The draft statement was presented to Council of Management on 27th April 2015. All staff were given the opportunity to comment and only positive feedback was received. The agreed statement was published onto our web site. We are informed that the Bill did not pass its second reading debate on 11 September 2015 and will make no further progress.

Clinical Strategy Development The CGC supported the development of the Clinical Strategy for Teesside Hospice. This included facilitated workshops where the mission statement was reviewed, our unique selling points were identified and objectives determined. This work was then shared at a joint meeting with Trustees and developed further towards the production of a Vision and Strategic Objectives document. A key output from this work was commitment from the Council of Management to a Development Fund. This will enable clinical projects to be funded and evaluated.

SystmOne Clinical Computer System

SystmOne is a clinical computer system produced by a company called TPP. It lets staff caring for NHS patients’ record patient information securely onto a computer. This allows communication between services using the system to be joined up, timely and secure. Work towards this project has been ongoing for several years. We are believed to be the only independent organisation to procure and implement this

20

system out with the NHS. The business go-live date was 21st March 2016. Evaluation, adaptation and development is ongoing.

The Clinical Audit Group The Clinical Audit Group has met 9 times from April 2015 to March 2016. This group has representatives from all departments and professional specialities and has overall been well attended within the last year. We have had a new member join us this year as a representative from the marketing team which has proven valuable to both parties.  

The audit group facilitated the usual audit programme but has undertaken a large review in December which resulted in a more streamlined audit programme that runs from January to December.  Each department has chosen a new topic to audit throughout the year as an attempt to engage more staff in the audit process and produce an increase in the number of positive evidence based changes resulting from audits.  The patient satisfaction surveys are now being evaluated from Jan – December in IPU & Day Hospice in order to ensure data is available when needed at the end of the financial year. The audit group have recently re-started the audit bulletin/newsletter to increase communication of audit findings.  

The audit group facilitated a project to review the website and there is now a system in place for regular reviews from the clinical team. The hospice leaflets have been reviewed through the process put in place last year and a new leaflet called "When someone is dying" has recently been produced.  

The audit group completed the patient experience report for 2015 – 2016 and ensured quarterly information for contract local quality requirements were undertaken each quarter throughout the year.

The Education Group

The Education Group meets on a 2 monthly basis and is well attended by designated representatives from each department and professional group. An education programme is planned each year which provides wide ranging, relevant, evidence and research based training to address all aspects of palliative care and other appropriate topics. Providing this education supports the requirements of national bodies for clinical staff with the aim being to directly or indirectly improve quality of life for palliative patients. 1-2 sessions per month are pre planned with the flexibility to add other topics into the program to address issues that have arisen. There have been 21 education sessions between April 2015 & March 2016 varying from 1 hour sessions to full training days for RGN’s and HCA’s. 290 staff in total have attended during that time which includes a small number of community nursing staff and other specialist palliative care team members. A representative of the group also attends the Specialist Palliative Care Education Group for South Tees. This provides a good link to share information about planned events and promote hospice services.

21

As part of staff support the reflective practice sessions continue bi-monthly and are well attended and the Breathing Space group now has two sessions per week to accommodate IPU nursing staff.

The Board of Trustees Statement

The Board of Trustees is fully committed to the provision of a high quality service at Teesside Hospice. The Hospice has a well-established clinical and corporate governance structure, with members of the Board playing an active part in ensuring that Teesside Hospice fulfils its mission, according to its charitable intentions and in ensuring that the organisation remains responsible and compliant in all areas of CQC registration, health and safety, employment law and other relevant legislation. This Quality Account was approved 23rd May 2016 Signed

Professor Brian Footitt OBE, Chairman, Board of Trustees of Teesside Hospice Care Foundation

22

10 June 2016 Statement from NHS South Tees Clinical Commissioning Group (ST CCG) for the Teesside Hospice Quality Account 2015/16. The CCG welcomes the opportunity to review and comment on the Quality Account for Teesside Hospice for 2015/16 and would like to offer the following commentary. NHS South Tees Clinical Commissioning Group (CCG) is committed to commissioning high quality services from Teesside 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 expectations of patients, their families and the public are listened to and acted upon. Overall the CCG feels that the Quality Account is presented in a meaningful way for both stakeholders and users and provides an accurate representation of the services delivered by the Hospice during 2015/16. We recognise the significant work that the Hospice has undertaken to drive quality improvements throughout the year, particularly in relation to improving patient handover processes. This will help to ensure that staff are fully appraised of the patient’s needs and can plan and deliver care appropriately and to a high standard. This is also enhanced by the improvements in the provision of clinical supervision to support staff. The CCG would also like to acknowledge the commitment from the Hospice Staff in achieving the Commissioning for Quality and Innovation goals agreed with the CCG for 2015/16. It is particularly encouraging to see that patients and their carers are actively enabled to contribute to the development of services through the surveys which have been undertaken. The staff should be commended on the excellent feedback received. The CCG supports the improvement aspirations outlined in the Quality Account for 2016/17, specifically the focus on improving the quality of discharge information through improved communication processes; the use of standard templates and the development of the Discharge Pack. We also commend the commitment to increasing support for Carers through further development of the multidisciplinary Carer Support Group; specifically through delivering increased numbers of sessions and using focused feedback to develop the content of the programme to include areas which Carers have found most helpful in the past. The CCG looks forward to continuing to work in partnership with the Hospice to assure the quality of services commissioned in 2016/17.

Mrs Amanda Hume Chief Officer NHS South Tees Clinical Commissioning Group

23

Healthwatch Middlesbrough

Catalyst House

27 Yarm Road

Stockton on Tees

TS18 3NJ

Tel 01642 688312

[email protected]

www.healthwatchmiddlesbroguh.co.uk

Mrs Andrea Clark Teesside Hospice 1 Northgate Road, Linthorpe, Middlesbrough TS5 5NW 9th June 2016 Dear Andrea, Teesside Hospice Quality Account 2015/16 Thank you for your email dated 20th May 2016, providing the opportunity for Healthwatch Middlesbrough to make comment on Teesside Hospice Quality Account 2014/15. The Quality Account was circulated to the Healthwatch Middlesbrough Executive Board for comments. The chair of Healthwatch Middlesbrough, board members and staff were all offered the opportunity to comment and feedback. Overall, Healthwatch Middlesbrough welcomes the opportunity to respond to the Quality Account and would hope it will continue to reflect the views the residents. Healthwatch Middlesbrough would like to commend Teesside Hospice for its attention to reviewing communications processes and incorporating patient experience feedback throughout this account. In particular, Healthwatch Middlesbrough hope that changes to discharge, the development of ACT document and the use of SBAR tool to facilitate the patient handover process will be of huge benefit to patients and look forward to seeing feedback on these changes from Teesside Hospice next year. Having read about the creation of a new social space for the Hospice which is used by patients, relatives and the User Forum, it would be beneficial to have any more detail available about the User Forum made publicly available (eg. how many participate, how often it meets and any operational changes that might have been made based on forum recommendations). Concerning the scores given by patients and families completing the three surveys (IPU, Day Hospice and Bereaved Carers), Teesside Hospice is to be commended on its dedicated work, which has clearly met and exceeded the expectations of

24

service users across all accounts. However the response rates to these surveys, while in context excellent in comparison to other service providers, still do not account for the majority of these patients and families. It’s also stated in the accounts that where surveys are returned indicating an issue with service, this is then investigated. It would be beneficial to have an indication of how many times this has been the case in the last year. In assessing patient and carer experiences of Teesside Hospice, it would be of great benefit to have a more detailed assessment of why they choose not to engage in these surveys. If then the majority of those not participating in these surveys are seen to decline the opportunity, it would be clearer whether or not this decision is based on any issue with service or actually other personal reasons. Of course, this might also show that completing these surveys is not appropriate for a majority of patients not responding. In either situation, it would be hugely beneficial to understand why this group have chosen not participate in order to understand if there are any underlying concerns that are then not captured. Lastly, the use of a variation of qualitative responses to service throughout the account is to be commended. It gives a real idea of how service is received by stakeholders, including both positive and negative aspects. It is clear from the report that you value the opinions of your patients and carers and we applaud the active way in which you involve them in helping shape future services and improvements. Yours sincerely, Paul Crawshaw Healthwatch Middlesbrough Chair