Quality Account 2017 -2018 - Home - St Lukes Hospice ... · It was the work of our team that enabled the Hospice to achieve finalist status in the Kate Granger Awards which recognises

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Quality Account

2017 -2018

St Luke’s Hospice

Nethermayne Basildon

Essex SS16 5NJ

Registered Charity No. 289466 and as a Company in England No. 1812104

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Contents Page Number Chief Executive Officer Statement 3 Priorities Identified for 2018/19 4 Reflecting on Priorities for Improvement set in 2016/17 for 2017/18 5 Statements of Assurance from the Board 8 Participation in Clinical Audits and Research 9 Quality Improvements and Assurance 11 What the CQC said about us 11 Clinical Quality Innovation 15 NHS Number and General Medical Practice Code Validity 15 Information Governance Toolkit Attainment Levels 15 Clinical Coding Error Rate 15 Comments about Services and Quality: 16

- Information Standard 16

- Trustee Provider Visits 16

- Staff Satisfaction Survey 17

- What our patients say about us 18 Duty of Candour 19 Safety 19 Review of Quality Performance April-March 2017/18 20 Statements from External Sources 21

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Chief Executive Statement The Annual Quality Account provides an opportunity to highlight the work of the Organisation within the last year. The Hospice is passionate about Service delivery and quality improvement. Within this report we highlight our ambitions for care, particularly extending that care beyond the traditional perceived scope of Hospice care and improving the quality of these Services at all opportunities. The report reflects the high level of patient experience and outcomes delivered by our staff and volunteers. We are immensely proud of our team who work tirelessly across the Organisation, whatever their role, to ensure that the patient experience is the best it can be and that the families of those patients are also supported. It was the work of our team that enabled the Hospice to achieve finalist status in the Kate Granger Awards which recognises the work of compassionate organisations. At its last visit the CQC rated the Organisation as Outstanding, which also recognises the commitment of our teams to strive for excellence. The Organisation will aim to maintain the high standards achieved but also has an increasing role to work alongside other healthcare professionals to ensure continuity of care to patients, improved learning through joint working and maximisation of resources for the public good across the local health economy. The Hospice works closely with Commissioners to deliver a cohesive strategy for End of Life Care and believes that our just approach has likely strengthened End of Life Care Services across the locality and provides a firm foundation upon which to strengthen Services in future years. To the best of my knowledge the information reported in this Quality Account is accurate and a fair representation of Services provided by the Hospice.

Eileen Marshall, Chief Executive, St Luke’s Hospice, March 2018

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Priorities for Improvement Identified for 2018/19 Priority One: Extending our award winning pioneering project for Advanced Liver Disease to people with other Long Term Conditions Development of a Heart Failure Pathway through the Heart Failure Clinical Nurse Practitioner (CNP) Grant The Hospice was successful in winning a grant from the St James Place Charitable Foundation in

conjunction with Hospice UK to develop a Shared Care Pathway for people with advanced Heart Failure

(£35,000). The model will be underpinned by the learning from the Shared Care pathway for people with

advanced Liver Disease. Working collaboratively with the Heart Failure team within NELFT and the

Consultant Cardiologists at BTUH, the project will enable early introduction to the range of supportive care

Services at the Hospice for patients and carers. The pathway will consist of Hospice staff attending

cardiology outpatient clinics within BTUH to meet Heart Failure patients, outpatient appointments at the

Hospice and holistic needs assessment, a targeted support group for patients and assessments and

support for carers. The project will run until April 2019.

Priority Two: Enhancing and extending the Frailty and Care Homes Palliative Support Service (FCHPSS) The Frailty and Care Homes Palliative Support Service will be enhanced and extended during 2018/19 building on the good work and outcomes achieved since Service set up. This will include on call duties such as being based at OneResponse to take calls from Care Homes, managing hospital discharges to Care Homes, investigating 111 calls, arranging work for the FCHPSS Health Care Assistant (HCA), collating 999 data, teaching, Non-Medical Prescribing, meetings (Care Home Sub Group/Care Home Mangers Meeting), follow up reviews patients on caseload (visits and via phone) and patient visits when patient requires Advance Care Planning. This will allow:

Hospital Discharges to be referred by BTUH earlier, allowing a FCHPSS Nurse to visit while the patient is still on the ward and building relationships and links with the frailty wards etc.

Nurse to attend BTUH Palliative MDT every Wednesday to identify Palliative/Frail Care Home patients that may not have been referred previously.

Build links in A&E In addition, the team will develop two projects. One looking at care home work broadly throughout BB, and the other exploring frailty, the Electronic Frailty Index (EFI) and its links to Services and the Register (Co-ordinated Care Register for End of Life) in Thurrock. Once the team is established, the plan will be for all EOL or Frail residents in Care Homes to be under the care of FCHPSS, Geriatricians or the Community Palliative Care Team (CPCT). Priority 3: Development of Stronger Partnerships Building on our Lead Provider role to develop the significant partnerships that have developed with other providers and the Clinical Commissioning Groups (CCG’s) we aim to embed, enhance and evolve stronger clinical and organisational pathways and partnerships to improve co-ordinated care pathways, increase positive Service outcomes and offer mutually supportive sustainability plans. Aligning with STP and national priorities we remain committed to improving care and practice across out locality. St. Luke’s Hospice are proud of its commitments to partnership, integrated working and aim to create innovative ways to continue this throughout 2018/19.

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Reflecting on Priorities for Improvement set in 2016/17 for 2017/18 Priority One: Extending our award winning pioneering project for Advanced Liver Disease (ALD) to people with other Long Term Conditions Following a successful pilot in 2013 the ALD shared care pathway was established following funding by The Health Foundation, to explore the impact of a collaborative approach to the care of patients with ALD and their carers. This innovative approach crossed traditional boundaries, giving patients and their carers early and timely access to the supportive care Services of the Hospice. Patient and carer outcomes:

• The evaluation demonstrated that the pathway maintained quality of life for patients who would be expected to deteriorate over this trajectory and enhanced their wellbeing.

• Similar benefits were observed from the carers contact with the Health Care Service Corporation (HCSC).

Key achievements:

• St. Luke’s Hospice is the first Hospice to offer an innovative and unique pathway for patients with ALD.

• Improved quality of care and well-being for this group of patients in addition to significant cost savings.

• St Luke’s Hospice embraced the national strategy to provide equitable palliative care for all. • Development of a shared care model that can be transferred easily to other non-malignant

conditions. • Abstract about the pilot accepted and full article printed in Gastro-Intestinal Nursing (July 17). • Project awarded the Hospice UK Innovation Award. • The comparative costs for acute activity associated with a sample of 10 patients were analysed and

resulted in a saving of £53,747 based on national tariff costs. Developing this model for people with other Long Term Condition’s will be a priority over the next few years, St. Luke’s Hospice has already sourced funding to extend the project in the first instance to people with Heart Failure and will be developing this Clinical Nurse Practitioner role for Long Term Conditions, into the future. Priority Two: Develop the Frailty and Care Homes Palliative Support Service (FCHPSS) to improve end of life care within Care Homes and support care home staff in the management of palliative and end of life patients St. Luke’s Hospice wanted to extend support and training for staff in care homes to ensure that people are able to die in their Preferred Place of Care/Death, supported by Services that are trained to manage their needs.

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Jan-March 2017 April-June 2017

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PPC/D Achievement

Total number of RIPs

Total number of patients who achieved PPC/D (out of RIPs)

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Key Achievements

• Care Home staff feel more supported and confident to support their residents to stay in their place of choice at end of life. This is reflected on the graph above which shows that overall 95% of patients in Q1 and Q2 2017 were able to stay in their place of choice at end of life.

• As patients’ individual choices are identified, understood and met there has been improved patient Experience and reassurance for patients as they are able to be cared for by staff they know and receive care in their home environment. The Service has been widely praised from across the organisations involved/who have received the Service.

• Since the Service has been in place, for those individuals in Care Homes that the Clinical Nurse Practitioner (CNP) has been working with, the reduction in re-admissions into hospital has saved over £5,000* based on the basic A&E tariff.

St. Luke’s Hospice Clinical Nurse Practitioner for Frailty and Care Home Palliative Support Service currently covers the South West Essex area. An additional post for the Thurrock CCG area has been reviewed, which will allow the existing post holder to focus on BB. The programme will be delivered throughout the next year by our in-house Quality and Education Service and Community Palliative Care Team along with the CNP’s. Priority 3: Deliver the Hospice UK Guidelines (2017) to increase the number of St. Luke’s Hospice Registered Nurses who are trained to verify expected deaths in the community (Verification of Expected Death – VoED) The CCG has worked with the Hospice over the past two years; as the lead provider for palliative and end of life Services for the population. Over the past two years St Luke’s Hospice staff have worked with primary care General Practices to implement the process for Verification of Expected Death (VoED). This means that for those patients who are dying at home they can have their death verified reducing the impact for families through unnecessary delays. The uptake for this Service has been well received.

To date (March 2018), 118 verifications of expected deaths have been carried out by Registered Nurses who have been trained and assessed as competent.

There are a total of 17 Nurses now competent to verify an expected death (13 of those are Hospice Community Services RN’s)

To date (March 2018), 76 GP practices signed up to Nurse VoED in total (which is an increase of 245% in 17/18 compared to 16/17)

The average time between OneResponse receiving the VoED request and the VoED being carried out was 1 hour and 36 minutes

Feedback received includes:

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Essex Success Regime

St. Luke’s Hospice has continued to work actively across the local health economy to develop strategy and support Service development. The pilot that we initiated in February 2017 to increase access to palliative care beds within the community has been relatively successful. We worked with the CCG and our community provider to offer beds within the community hospitals especially for end of life patients not requiring specialist intervention. We put in place a training programme for community hospital staff and provided specialist nurse time to support staff to manage this cohort of patients. This enables people to be cared for closer to their home but with the right level of care in the last few weeks of life. The Community Bed project and outcomes until January 2018 was presented at the February STP End of Life Care Subgroup. There will be ongoing work to continue to roll out education, End of Life Care Champions and embedding of the pathway. Outcomes include:

From the start of the pilot to 31st January 2018, a total of 279 Acute Bed Days saved

Improved flow from acute to community for those meeting pilot criteria (measured on reduction in length of stay and Excess Bed Days for this group and reduction in this group of patients dying in the acute setting)

Facilitate discharge from acute by reducing delays associated with the transfer to nursing/care homes where this was not the persons place of residence pre-admission (measured through a reduction in DTOCs for this group)

Improvements in patients achieving their Preferred Place of Care/Death

Supporting those with non-specialist care needs to be discharged to assess for their on-going care needs

Improved awareness of those on the Coordinated Care Register (EOL Register)

Monitoring of ongoing care needs/provision at end of inpatient (pilot stay):

- Died in IC Bed - Discharged with RADS - Discharged with Supportive Services (social care/health care) - That care and outcomes are in line with the individuals coordinated care plan

Use learning and outcome of the pilot to inform continuation and expansion of the model

Localised Voices Survey for relatives/patients to capture their experience

Staff experience survey

Capture unmet need – potential need of this Service

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Statements of Assurance from the Board Review of Services - During 2017/18 St Luke’s Hospice provided the following Services: Hospice Community Services:

OneResponse – Support Assessment and Advice Service

Rapid Assessment and Discharge Service - Fast Track Care

Hospice at Home

Frailty and Care Homes Palliative Support Service

In-Patient Services Day Hospice Out Patients Counselling Services (Adults) Counselling Services (Children and Young People) Community Palliative Care Team Lymphoedema Services, including non-cancer and primary, across South Essex Specialist Physiotherapy Service Social Work Service Complementary Therapy Service Information Resource Service and Information Centre Quality and Education Service Carers Support Service Creative Choice Therapies Shared Care Liver Project The Hospice has reviewed all the data available to them on the ‘quality of care’ in all of these NHS Services. The income generated by the NHS Services reviewed in 2017/18 represents 49% of the total income generated from the provision of NHS Services by St Luke’s Hospice for the reporting period 2017/18.

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Participation in Clinical Audits and Research Hospice Community Services Hospice Community Services - 2 RNs have received training on DNARCPR and will be completing their competencies soon so as to support our patients, with a further 3 RNs planned to attend 2018 Hospice Community Services have streamlined their audits - they used the family and friends audit quarterly in OneResponse and an annual audit (based on Hospice UK H@H standards). Care team patients are always sent a questionnaire to monitor standards. Now in line with the whole Hospice OneResponse and H@H are using the 5 x 5 audit - this has shown some low risk areas which can be addressed, e.g. about patient visit times. Hospice Community Services have worked with NIHR Clinical Research Network: West Midlands on piloting a triage tool for Hospice Services. The pilot has been completed and sent to the Research team for evaluation. Change to practice so far, while waiting for report, has been that a follow up case load is needed and has been implemented. The learning is that the Service cannot support complex cases with one intervention, but need to ‘hold’ the cases until they are supported by other Services. External Audits Completed National Comparative Audit of Red Blood Cell Transfusion in Hospices This was a prospective national audit of current clinical practice. The patient group were adults aged >18 years old who were given a red blood cell transfusion in a Hospice. Units collected data for 3 months within the data collection period of September 2016 to December 2016. Each transfusion was included as a separate audit episode number, unless additional units were transfused within a 24-hour period. The audit data from the transfusion episode was entered via a web-based audit tool specifically designed for the purpose. Action Plan

Results and recommendations of audit were discussed with Hospice Consultants and members of the Clinical Reference Group and any changes to be implemented throughout the Organisation and the Blood Transfusion policy will be amended to reflect the changes.

A re-audit of blood transfusions will take place internally at the end of the year ensuring that any recommendations put in place are audited. This may require a light amendment of the questions asked.

End of Life Care Audit 2017: NICE Quality Standard 144 Care of Dying Adults in the Last Days of Life This audit was carried out to assess the evidence for the care given in the last days of life. It was part of a larger audit carried out across the locality in acute trusts and Hospices. Data for all deaths in the Inpatient Unit during May 2017 was collected using a standard data collection sheet. There was a total of 8 deaths during the audit period. Recommendations and Actions

The findings demonstrated an overall compliance with the NICE Quality Standard 144 Care of the Dying Adult in the Last Days of Life.

The audit identified that hydration status does not appear to be assessed daily and the risk and benefits of hydration are not documented as being discussed. It was identified that this does happen in clinical practice but is not always fully documented. There is clear documentation on the End of Life Care plan that patients are offered diet and fluids as tolerated but this does not demonstrate an assessment of their hydration status. An action leading from this was to implement a Daily Assessment of End of life needs for all patients on the End of life care plan. This includes a section on Hydration and Nutrition status. A re-audit to demonstrate full compliance will be undertaken.

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Hospice at Home-SPDNS Annual Audit 2017 Using the National Association for Hospice at Home (NAHH) national standards audit tool an annual audit for the Service was undertaken between May and June 2017. The audit sought to confirm that the Service is operating according to NAHH standards and highlight any areas for improvement. It covered 5 key areas:

1. Policies and Procedures 2. Monitoring and Reporting 3. Patient/relative/carer feedback 4. Hospice at Home team feedback 5. Professionals questionnaire

Action Identified Plan

Amalgamating separate Operational Policies into one Operational Policy for all entire Hospice Community Services there should be a very transparent document describing a complex Service with multiple employers working together for a common aim.

Complete by November 2018. Use existing policies while work in progress.

There needs to be work to address how we seek team, Service user and professional feedback.

By reviewing all questionnaires before the next audit in 2018. Currently trialling a 5x5 Service user feedback questionnaire which replaces satisfaction surveys.

Internal Audits Completed

Collaborative Peer Review, South Essex Lymphoedema Service (SELS)

Complaints Management Process Review (over the last 3 years)

Hospice UK Infection Control Audit – Module One, Policies and Procedures (Organisation wide

Hospice UK Infection Control Audit – Module Two, Hand Hygiene (all sites)

Hospice UK Infection Control Audit – Module Three, Patient Areas (Organisation wide)

Hospice UK Infection Control Audit – Module Four, Clinical Rooms

Hospice UK Audit, Day Hospice

Hospice UK Audit – Nutrition

Hospice at Home Full Audit

Management and Safe Handling of Storage of Medication Audit, In-Patient Unit

Medications to take home (green cards), In-Patient Unit

Record Keeping Audit (OACC Process), In-Patient Unit and Day Hospice

Risk Management Spot Checks, In-Patient Unit and Day Hospice Satisfaction Surveys

Day Hospice Out-Patients Satisfaction Survey

Dove Community Counselling Service Client (all Clients) Satisfaction Survey

Dove Community Counselling Service Group Satisfaction Survey

Dove Community Counselling Service Supervision, Support, Education and Communication of Counsellors Placements

Luke’s Adult Group and Child Group Satisfaction Survey

Staff Survey for Education, Training and Supervision (Organisation wide) Currently IPU, DH IRS, CPCT and OneResponse are trialling a 5x5 Service user feedback questionnaire which replaces the satisfaction surveys which these teams have previously conducted. Each department contacts 5 patients/carers randomly either face to face or by telephone, to receive feedback on the Service that they have received by answering 5 prepared questions. The five patients, on the caseload and receiving care, are selected at random and this is repeated every month with a different five patients.

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This helps to improve Services and to rectify any problems that may arise. This was initially piloted between the months of October and December and will report back in January. This is reported in Governance and Quarterly as part of the Audit Programme and will become a Hospice wide initiative. Quality Improvement and Assurance What others say about us St Luke’s Hospice is required to register with the Care Quality Commission and its current registration status is outstanding. The Hospice has no conditions on registration. The Care Quality Commission has not taken any enforcement action against St Luke’s Hospice during 2017/18. St Luke’s Hospice has not participated in any special reviews or investigations by the Commission during the reporting period. St Luke’s Hospice is subject to periodic reviews by the Care Quality Commission and its last review was in December 2016. Arising from the inspection the Hospice was deemed to be compliant with no actions to take arising from the Commissioner’s assessment. The Hospice was rated as Outstanding.

What the CQC Said About Us

“The Care Quality Commission has found the quality of care provided by St Luke’s Hospice in Fobbing Farm, Nethermayne, Basildon, to be Outstanding overall following an inspection in December. St Luke’s Hospice is registered to provide specialist palliative care, advice and clinical support for adults with life limiting illness and their families. The Service provides care for people through an inpatient unit, day Service and outpatient care. The Hospice is also contracted with a registered nursing care provider to run a ‘Hospice at home’ Service. Inspectors found staff were caring and compassionate and people were being provided with safe, responsive, caring, effective and well led care. A full report of the inspection has been published on our website http://www.cqc.org.uk/location/1134065030”

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Under CQC’s programme of inspections, all adult social care Services are being given a rating according to whether they are safe, effective, caring, responsive and well led. St Luke's Hospice was rated Outstanding overall, Outstanding for being Caring, Well Led, Responsive And Effective and Good for being Safe. Jemima Burnage, CQC’s Head of Inspection for Adult Social Care in the central region said: “Our inspection team were really impressed by the level of care and support given to those using St Luke’s Hospice." “People and families received care from staff and volunteers who developed positive, caring and compassionate relationships with them. The Service promoted a culture that was caring and person centred. Staff worked together as a multidisciplinary team to provide the care people wanted and needed."

“People who used the Hospice at Home Service and their relatives told us staff were always on time and spent as much time with the person as needed. One person told us, "It is so comforting to know they are coming. It is a lifeline." “People in the In-Patient Unit told us their needs were met by staff at all times and staff had time to spend with them as much as they needed. On the day of the inspection we saw there were plenty of staff assisting people in an unhurried way, call bells were answered promptly and staff were seen talking to people and their relatives as often or as long as there was a need for it. One person told us, "There are always plenty of staff. They never ever rush you or make you feel that you are a nuisance." “People and relatives we spoke with said they thought all the staff were well trained and delivered an excellent Service which was effective and met their needs. One person said, "They are all very knowledgeable and give sound advice and support." “People told us and we saw that they were asked for their consent to the care and the Services they received from the Hospice. One person told us, "I am always asked what I want and I can take decisions." Another person said, "I am involved in my care and they always ask if it is `okay` to do something." “People and relatives were overwhelmingly positive about the care provided by the Hospice staff. They told us staff were approachable and showed empathy towards people. People and relatives told us staff were exceptionally friendly, kind and caring. One person told us, "They are brilliant; caring and kind." Another person said, "Staff are all marvellous, very compassionate and caring." One relative said, "I cannot wish for better.” “Our inspection team were really impressed by the level of care and support given to those using St Luke’s Hospice." “People and families received care from staff and volunteers who developed positive, caring and compassionate relationships with them. The Service promoted a culture that was caring and person centred.

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Staff worked together as a multidisciplinary team to provide the care people wanted and needed." “We found that the Service was extremely caring and focused on providing a tailored Service. People and relatives said staff were well trained and delivered an excellent Service which was effective and met their needs." Summary from the CQC Inspection This inspection took place on 14 December 2016 and was unannounced. Following the inspection we received feedback from family members of the people who used the Service, volunteers and other Services working in partnership with St Luke`s Hospice. St Luke`s Hospice is registered to provide specialist palliative care, advice and clinical support for adults with life limiting illness and their families. The Service delivers physical, emotional, spiritual and holistic care through teams of nurses, doctors, counsellors and other professionals including therapists. The Service provides care for people through an In-Patient Unit, Day Service and Out-Patient Care. St Luke`s Hospice contracted with a registered nursing care provider to run a 'Hospice at home Service'. The Hospice at home Service and a fast response team called 'OneResponse' were based and had their offices in St Luke`s Hospice and offered a Service for people with palliative care needs living in the community. The 'One Response' Service was an innovative fast response Service which offered support, assessment and advice to people with life limiting condition living in their own homes over 24 hour seven days a week. The support could be accessed via telephone where the call was triaged and staff could arrange specialist visits to people within two hours. This Service was run in conjunction with Macmillan nurses, Marie Curie nurses and end of life specialists. At the time of our inspection the Service was supporting approximately 300 people either with direct care or by telephone support. At the time of the inspection there were three people using the inpatient Service and around 500 people using day Services. The day Services offered a range of Services to people recently diagnosed with life limiting conditions, their carers and families. The Service provided specialist advice, courses, complementary therapy sessions and outpatient clinics. It aimed to empower people to be in control of their condition and achieve what was important to them. St Luke`s Hospice had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the Service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the Service is run. Staff had permanent support and guidance from a social care professional employed by the Hospice and were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to report any concerns they had. Risks to people`s well-being were assessed by staff daily and there were measures in place to mitigate risks and keep people safe. Risk assessments were reflective of people`s changing abilities and needs and measures to ensure people were as safe as possible were implemented accordingly. People received care based on best practice from experienced staff with the knowledge, skills and competencies to support their complex health needs. People and families received care from staff and volunteers who developed positive, caring and compassionate relationships with them. The Service promoted a culture that was caring and person centred. Staff worked together as a multidisciplinary team to provide the care people wanted and needed. People told us they were fully involved in setting their priorities for care. Care plans in regard to all aspects of people`s medical, emotional and spiritual needs were personalised and written in partnership with people. Staff delivered support to people respecting their wishes and preferences. People who used the various Services offered at the day Hospice told us the help and support they received was invaluable for them and their family. They valued the support they received from the different activities, courses and clinics which helped them to live with and manage their symptoms to maximise their health and helped them prepare for the future. They also appreciated the opportunity to meet with people in similar conditions and the social aspect of the Services provided. People told us that staff understood their individual care needs and were compassionate and understanding.

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Staff told us they undertook training which enabled them to provide good quality care to people in the In-patient unit, in the community and in the Day Hospice. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Staff reported any concerns so these could be reviewed and discussed to identify if lessons could be learnt to reduce the likelihood of recurrence. Recruitment procedures were robust and ensured that staff working at the Service were qualified and skilled to meet people`s complex needs. Staff told us they worked and trained towards their personal development plans and were happy with the support from their managers. There were sufficient numbers of staff to ensure people received support when they needed it. People's medicines were administered by trained and qualified staff who had their competency to give medicines safely assessed regularly by their manager. Any changes in people`s medication were discussed by the medical team, nurses and pharmacist to manage and support people's symptoms and pain management. Medicines were regularly reviewed and audited to ensure they met people's needs. The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were dedicated in their approach to supporting people to make informed decisions about their care. The registered manager was committed to improve and broaden the Services the Hospice offered. They established seamless working relationships with other organisations to be able to reach out to as many people with complex needs as possible. They were constantly involved in research and development of new Services together with partner organisations and promoted coordinated personalised care for people in the community. The Services provided by the Hospice had the support of volunteers who were closely involved in every aspect and department the Hospice operated. The Service actively encouraged and provided a range of opportunities for people who used the Service and their relatives to provide feedback and comment upon the Service in order to continue to drive improvement. There was a comprehensive auditing programme for all the Services the Hospice provided carried out by the quality and education Service team. Action plans were comprehensive in detailing actions taken, time frames and the person responsible for the actions.

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Clinical Quality Innovation A proportion of St. Luke’s Hospice income was conditional on achieving quality improvement and innovation goals (CQUINs – Commissioning Quality and Innovation) agreed between the Hospice and Basildon and Brentwood and Thurrock CCG’s. CQUINs agreed were defined as:

Verification of Expected Death

Develop the Frailty and Care Homes Palliative Support Service to improve end of life care within Care Homes

Key Achievements - Verification of Expected Death

To date (31st March 2018), 118 verifications of expected deaths have been carried out by Registered Nurses who have been trained and assessed as competent, 97% were known to Hospice Community Services (70% have been carried out in out of hours)

To date (31st March 2018), 76 GP practices signed up to Nurse VoED in total (which is an increase of 245% in 17/18 compared to 16/17)

The average time between OneResponse receiving the VoED request and the VoED being carried out was 1 hour and 36 minutes

Key Achievements - Frailty and Care Homes Palliative Support Service

• Care Home staff feel more supported and confident to support their residents to stay in their place of choice at end of life. This is reflected on the graph on page 6, which shows that overall 95% of patients in Q1 and Q2 2017 were able to stay in their place of choice at end of life

• Since the Service has been in place, for those individuals in Care Homes that the Clinical Nurse Practitioner (CNP) has been working with, the reduction in re-admissions into hospital has saved over £5,000* (*based on the basic A&E tariff)

Both CQUINs were successful and in order to build on and further embed the progress made to date the two CCG’s have agreed to continue with similar CQUIN’s for next year. NHS Number and General Medical Practice Code Validity St Luke’s Hospice did not submit records during 2017/18 to the Secondary Users Service for inclusion in the hospital episode statistics, which are included in the latest published data. Information Governance Toolkit Attainment Levels St Luke’s Hospice attained 88%. Clinical Coding Error Rate St Luke’s Hospice was not subject to the Payment by Results clinical coding audit during 2017/18 by the Audit Commission.

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Comments about Services and Quality Information Standard The Hospice achieved the Information Standard in December 2013 (The first Hospice to do so nationally). The aim of the standard is to provide confidence to the public and patients to make informed choices. The accreditation allows the Hospice to use the Information Standard logo on relevant future care and treatment information following a robust ratification process of printed care literature. The Hospice was pleased to successfully receive re-accreditation in December 2016. NHS England now host the Information Standard and information on the future re-accreditation process is awaited. In line with national guidelines the St. Luke’s Hospice is working to the Accessible Information Standard, ensuring that relevant Hospice information can be communicated to everyone who may need it, in the format that is most appropriate to them e.g. large print and audio format for people with visual impairment use of interpreters for people whose first language is not English and the use of text and email messaging for people with hearing impairment. Trustee Provider Visits The Trustees continue to review activity and performance through a range of processes including six monthly Provider Visits. The visits provide an opportunity for Board members to meet with patients, families, staff and volunteers to assess the performance of the Organisation and satisfaction levels from all groups. The visits are viewed as highly positive in enabling the Trustees an insight into the operational effectiveness of the charity as well as demonstrating to the various groups interviewed the impatience placed by the board on Service, quality and satisfaction. The Trustees continue to receive positive feedback from all of the groups and reflect on the findings of the visits at full Board meetings, with a requirement from the Chief Executive or Director to respond to points raised and to implement changes if necessary. Overall, the visits are affirming and well received by all.

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Staff Satisfaction Survey A staff satisfaction survey is undertaken annually, with 100% of participants recommended the Hospice as a good place to work. It was evident that many who participated gave a lot of thought to their responses and comments made. The comments on aspects of their job that staff particularly like are very positive, heart-warming and varied. It is welcomed and much appreciated that our staff enjoy so many aspects of their diverse and often difficult roles and all, regardless of where they work or what they do, relish being part of the Hospice team. The communication ratings are much better in 2017 compared to 2016 which is a positive move in the right direction but we will ensure good communication continues to be a priority as it is vital we have an excellent flow of information and ideas exchange as the Hospice expands and develops. Finally there were some extremely positive and heartfelt comments made about how staff feel about their jobs and working at the Hospice generally. Every effort will be made to ensure that being an employee of the whole St. Luke’s organisation will continue to be a happy and rewarding experience and St. Luke’s an employer of choice. Comments from the survey included:

“I have had poor management experiences in the past and feel extremely lucky to have such a wonderful supportive Manager and team to work with who are all open and approachable”

“I have a very good working relationship with my Manager and our team. We are all supportive of each other and although we do different roles we happily stand in for each other when necessary i.e. taking minutes of meetings etc.”

“I feel I work in an environment where I can openly discuss issues and feel supported”

“I love working within such a worthwhile organisation. I feel our team make a difference. I feel privileged to work for St Luke’s. I feel St. Luke’s is a wonderful, special place to work. The support and guidance that I receive helps me to fulfil my role successfully and feel motivated to work as hard as I can to meet and exceed expectations and support and improve the organisation where I can”

“I am proud to work for the Hospice”

“As a new employee I enjoy working for the Hospice. I have felt fully supported since I have started and am very happy in my role”

“After 27 years I still feel so privileged to be a part of St Luke’s and could never envisage enjoying anything more”

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What our patients say about us Satisfaction surveys are regularly used across Services to assess patient satisfaction levels. Patients and carers also have the opportunity to comment on care by submitting comment cards which are readily available and can be anonymous. A selection of comments received are detailed below. “We couldn’t have got better care. Thank you so much for your hard work looking after my wife while she has been here. You have done so well and have given her, as well as me peace of mind. You all work so hard in looking after your patients. Thank you so much” “We would like to thank you from the bottom of our hearts for the so kind and thoughtful care and attention you have given us. We would never have coped otherwise. Thank you, thank you, and thank you” “Wednesday Hospice’ thank you for all your care, kindness, support and most of all the laughter” “I can never thank you all enough for your care, support, love and help. I’ve told everyone how so wonderfully caring and loving you all are. I feel privileged and grateful to have been invited to be a part of the St. Luke’s family. I have made so many friends and will never forget you all, you all make such a difference and I won’t ever forget you” “It has been a tough year, especially the last few months, but the visits and care from the OneResponse team and nurses has been invaluable to both XXXX and us his family. He couldn't have been cared for as well, or us to receive advice without this care. We are also so very grateful to the Hospice Team that cared for him during his last few days, and for the help provided for his wife. To all these people we are very thankful and will not forget your kindness” “It is very much appreciated, knowing you are there really helps. They were very upbeat yesterday after their visit from St Lukes even Dad was animated - he even helped me put the bins out – I know that sounds pathetic but those little small things help me feel like he’s my Dad” “I never imagined how helpful and emotional the sessions could be. My counsellor had an amazing gift of making me feel comfortable, whilst knowing exactly the right things to say. Thank you so much” “I found that the advice helped me to see beyond the tough times. Talking to someone as caring and knowledgeable as my counsellor showed me that life does get a little easier with time. Also you can go on to rebuild your life despite all the trauma that has gone before”

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Duty of Candour St. Luke’s Hospice execute our duty of candour as required by CQC Regulation 20, ensuring that patients and their families are informed of any medical error regardless of severity. In the event of any incident, investigations are carried out in a timely manner and any incident shared and action taken to ensure that all staff learn from incidents within the Hospice and that there are no recurring errors. Patients and their families are offered support by suitably qualified staff and will receive a formal apology from St. Luke’s Hospice detailing the outcome of the investigation. Safety The CQC awarded St. Luke’s Hospice a rating of GOOD for safe. Whilst we are pleased to receive this we will strive to gain outstanding in our next inspection. Since the CQC visit a Task and Finish Group has been set up to look at new regulation and at our patient safety. They feed back through the Strategic Quality Steering Group and Monitoring of Incidents Committee. Members are co-opted as required and some slight change to processes have already been introduced. The Hospice has also been shortlisted to the finals of the HSJ 2018 Patient Safety Awards under the Palliative Care category to highlight our quality governance framework and patient safety initiatives.

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Review of Quality Performance April to March 2017/2018 Hospice Community Services Other Hospice Support Services

OneResponse received 32,263 calls Of these, 16,485 were referrals/episodes of care

Hospice Community Services helped to maintain care at home for people with palliative

and end of life care needs leading to 1,579 avoided hospital admissions, of which

1,188 were during the “out of hours” period.

The Specialist Physiotherapy

Service received 343 referrals

and supported 1,878 patients through

face to face and group contact

The Information Resource Service

had 3,247 face to face enquiries

and made 6,980 actions on

enquiries

Dove Community Counselling (our adult

counselling Service) received 1,765

referrals and carried out 2,916 face to face sessions

Our Social Work Service received

237 new referrals and our

Carers Support Service received

340 referrals

The South Essex Lymphoedema Service received 406 referrals which is an

increase of 8.5% compared to the previous

year and there were 1,788 clinic attendance

Hospice at Home received 853 new

referrals which is an increase of 30% over the last 3 years

The Rapid Assessment and Discharge Service

(Fast Track Care) received 690 referrals and

delivered 16,248 hours of care

Our new Frailty and Care Homes Palliative

Support Service received 699 referrals during

the year

The Community Palliative Care Team received 896 referrals since

July 2017 when they transferred to the Hospice

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In-Patient Unit, Day Hospice and Out-Patients

Statements from External Sources

Basildon and Brentwood Clinical Commissioning Group response to the Quality Account The CCG has worked with the Hospice over the past year; as the Lead Provider for palliative and end of life Services for the population. Over the past year St Luke’s have worked with our primary care General Practices to implement the process for Verification of Expected Death (VoED), this means that for those patients who are dying at home they can have their death verified reducing the impact for families through unnecessary delays. The uptake for this Service has been well received. St Luke’s Hospice have supported the CCG in delivery of Services that have delivered benefits to patients and their carers/families and also the CCG. These have been recognised by NHS England as opportunities for other CCGs as models of good practice. In partnership with the CCG, St Luke’s Director of Commissioning, Integration and Development, Deb Hickey and their Compliance Support Officer, Laura Bone have attended regional NHS England events with the CCG to talk about these schemes and the opportunity and benefits that they have delivered. In response to system challenges and as part of a CQUIN (Commissioning for Quality and Innovation), St Luke’s have introduced a training programme supporting both Nursing and Residential Care Homes across south west Essex. The schemes have been well received, with the impact being evaluated to inform future commissioning of the Service. The Hospice were awarded in April 2017, the Care Quality Commission rating of outstanding reflecting all the hard work that they deliver for the local population (http://www.cqc.org.uk/location/1-134065030?referer=widget4). Karen Wesson Director of Commissioning Joint Committee Team Mid and South Essex

There were 203

admissions to the

In-Patient Unit

Our Day Hospice received 306

referrals with an annual attendance of

2,006 visits and there were 626 attendances at

Out-Patient Clinics

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Thurrock Clinical Commissioning Group response to the Quality Account NHS Thurrock CCG welcomes the opportunity to comment on the annual Quality Account prepared by St Luke’s Hospice as co-commissioner of the service. To the best of NHS Thurrock CCG’s knowledge, the information contained in the Account is accurate and reflects a true and balanced description of the quality of provision of services. Highlights from 2017/18 The CCG notes the progress against the priorities identified for 2017/18. The first priority the CCG is pleased to note is that the award winning pioneering project for a collaborative approach to the care of patients with Advanced Liver Disease is being extended to people with long term conditions. The development of the shared care model will also be easily transferred to other non-malignant conditions and that funding has been sourced to extend the project to people with Heart Failure. The second priority to improve end of life care within care homes has enabled 95% of residents in Q1 and Q2 to stay in their place of choice at the end of their life. The third priority the CCG commends is the project for Verification of Death (VoED). This project has been running for two years and the CCG welcomes this development which enables people to die at home and have their death verified, thus reducing the impact for families through unnecessary delays. The average time between receiving the request for VoED and this being carried out was 1 hour 36 minutes. Priorities for 2018/19 The CCG is pleased to note that the Hospice has identified the following priorities for improvement: Priority 1- to extend the project for advanced liver diseases to people with other long term conditions and also the development of a Heart Failure pathway. Priory 2 - to enhance and extend the frailty and care homes palliative support service to improve end of life care in care homes. For Thurrock it is noted that there is an additional project that will be exploring frailty the electronic frailty index (EFI) and the links to the co-ordinated care register for End of Life Care Priority 3 –Building on the lead provider role for the development of stronger partnerships with other providers and the Clinical Commissioning Groups. This will align with the STP and national priorities. Patient and Staff Feedback It is apparent from the detail in the Quality Account that staff report that they are very proud to work for this organisation the annual staff satisfaction survey highlights that 100% of participants would recommend the Hospice as a good place to work and this is reflected in the wonderful patient feedback. NHS Thurrock CCG is fully supportive of all the priorities identified by St Luke’s Hospice in taking forward the patient safety, effectiveness, experience and involvement agenda and looks forward to working in partnership with the Hospice in the forthcoming year.

Jane Foster-Taylor Chief Nurse, Thurrock CCG

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Healthwatch Response to the Quality Account Healthwatch Essex is an independent organisation that works to provide a voice for the people of Essex in helping to shape and improve local health and social care. We believe that health and social care organisations should use people’s lived experience to improve services. Understanding what it is like for the patient, the service user and the carer to access services should be at the heart of transforming the NHS and social care as it meets the challenges ahead of it. We recognise that Quality Accounts are an important way for local NHS services to report on their performance by measuring patient safety, the effectiveness of treatments that patients receive and patient experience of care. They present a useful opportunity for Healthwatch to provide a critical, but constructive, perspective on the quality of services, and we will comment where we believe we have evidence – grounded in people’s voice and lived experience – that is relevant to the quality of services delivered by St. Luke’s Hospice. In this case, we have received quality of feedback about services provided by the Hospice, and so offer only the following comments on the St. Luke’s Hospice Quality Account.

What is very encouraging to see is the recognition from the CQC that St. Luke’s Hospice is an outstanding organisation. It is also always positive to see such a good mixture of staff and volunteers working for an exceptional cause.

The Hospice is playing a key role in supporting the changing face of health & social care. As the world around St. Luke’s Hospice changes the Hospice remains dedicated to its role of support of its patients and the best quality of care at the end of life.

The Hospice is clearly a system leader around liver disease and nurse training which is so important in the workforce planning.

Listening to the voice and lived experience of patients, service users, carers, and the wider community, is a vital component of providing good quality care and by working hard to evidence that lived experience we hope we can continue to support the encouraging work of St. Luke’s Hospice. Dr David Sollis Chief Executive Officer, Healthwatch Essex