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Quality Account

2018 -2019

St Luke’s Hospice Nethermayne

Basildon Essex

SS16 5NJ

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

“I feel extremely privileged to have had a period of respite and assessment in this

fantastic facility. The care and attention to detail are second to none. It is clear that from the manager in charge to the many volunteers, the staff really care for and

about each other as well as the patients. It is an extremely nurturing environment”

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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 2017/18 for 2018/19 6 Sustainability and Transformation Plan (STP) 10 Statements of Assurance from the Board 11 Participation in Clinical Audits and Research 12 What the CQC said about us 15 Clinical Quality Innovation 17 NHS Number and General Medical Practice Code Validity 17 Information Governance Toolkit Attainment Levels 17 Clinical Coding Error Rate 17 Comments about Services and Quality 18

- Information Standard 18

- Trustee Provider Visits 18

- Staff Satisfaction Survey 19

- What our patients say about us 20 Review of Quality Performance April-March 2017/18 21 Statements from External Sources 22

“I would like to say how grateful I am for the care and treatment

I received here in this unit. The staff could not have been more

kind or helpful. When my time comes for me to go, this is the

place I want to be. What really kind and wonderful people you

have here. Thank you.”

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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. In the Hepatology/Liver Nurse Award category for the BJN Awards 2018 we were shortlisted as a finalist, coming in 2nd place. The Hospice was 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. The Hospice was proud that four of the Organisation’s volunteers received recognition for their contribution to the work of the Charity at the Basildon Volunteer Awards. 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 partnership approach has likely strengthened End of Life Care Services across the locality and provides a firm foundation upon which to embed and deliver 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 2019

“Everything and more than could be expected.”

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Priorities for Improvement Identified for 2019/20 Priority One: Continuation of Heart Failure Pathway through the Heart Failure Clinical Nurse Practitioner (CNP) Grant

Embedding the Liver Project and Heart Partnership project work across the Organisation

Disseminate the learning gained from previous shared care pathways on a local and national level to facilitate wider Service improvement

Following completion of the Heart Partnership Project, embed the role of Clinical Nurse Practitioner for Long Term Conditions across the Hospice

Develop a shared care pathway for people with end stage kidney disease working closely with our renal team colleagues from BTUH (grant dependant for initial project)

Enhance and embed the care and support offered to people affected by Dementia

Strengthen links with professionals working in neurology specialities to raise awareness of the role the Hospice can play in supporting people with advanced neurological disease. This includes attendance at the monthly MND clinic at BTUH to promote early referral to Hospice Services

Priority Two: Extending the Frailty and Care Homes Palliative Support Service (FCHPSS) FCHPSS has become increasingly embedded as a local Service over the last year. Building on progress so far the team plan to enhance the existing Service as follows:

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 FCHPSS Service plans to:

1. Work with CCMT, Trusted Assessor - Potentially share data with them so FCHPSS can see details

of the Care Home Residents that are currently in BTUH (not wait to hear about them upon

discharge or death)

2. Produce recommendations for pathways after working with A&E, Frailty Wards/Team etc. (how

FCHPSS can help turnaround residents in A&E and/or speed up discharge)

3. Continue the analysis of 999 and 111 data to produce a report on themes regarding the common

reasons for calls, how many of those resulted in an A&E attendance, the Care Homes who call the

most, the residents who are the subject of recurrent calls etc., developing action plans for each care

home depending on the themes shown

4. Report on the ‘avoidable’ Care Home resident admissions and subsequent deaths in BTUH –

communicate this to Care Homes for future learning and admission avoidance

5. Continue working with St. Luke’s Hospice Quality and Education Team on the 3 day End Of Life

Care Education Course for Care Homes and the Champion Sessions – spreading the word on

FCHPSS

6. Report on the impact of any prescribing episodes and what would have happened if this clinical

input wasn’t available

7. Report deaths that occurred while the patient was on the FCHPSS caseload – where PPD was not

achieved; the Route Cause Analysis (RCA) to be communicated to the Care Home for learning and

increased admission avoidance

8. Develop the Care Home Subgroup and Managers meetings to improve communication and share

experiences – alternate months throughout 2019/20

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Priority 3: End of Life Register - Development of Stronger Working Partnerships

To continue to review the use of the electronic Co-ordinated Care Register (eCCR) in order to be able to

identify the 1% of the population to ensure improved Advance Care Planning (ACP) and that the person is

known to relevant Services

To promote and educate/upskill all teams around referral to the eCCR and use this as an opportunity to

educate about ACP

To monitor and report Register Activity, identify emerging/key themes to inform Service delivery and

development and related commissioning.

To embed quarterly meetings to review progress and agree future actions

To demonstrate increased numbers of referrals to register and exception report any decline

To implement pre-emptive measure (ACP) to avoid recurrence.

To support and participate in the roll out and use of community TEP’s e.g. PeACE, using this as part pf

ACP and linking with use of the eCCR

To review the additional electronic register (list) of people that are not yet eligible for the eCCR but have

some form of ACP e.g. DNAR and identify/compare emerging/key themes with those of the eCCR

To analyse and compare both lists to inform future Service development and delivery and commissioning.

To develop pilot Advance Care Planning Clinic in Day Hospice and review outcomes. To roll out the IAM document as part of the pilot clinic and review uptake.

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Reflecting on Priorities for Improvement set in 2017/18 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 was 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 has enabled early introduction to the range of supportive care services at the Hospice for patients and carers. The pathway consisted 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 Heart Partnership Project has been running for almost one year. In addition, an IV furosemide pathway has been developed to allow improved symptom management of fluid overload. It is hoped that this pathway will not only improve the quality of life for patients suffering with this difficult symptom but that it will also avoid unnecessary hospital admissions. Full data analysis of the project commenced on April 1st 2019, however, early qualitative feedback is showing a definitive improvement in quality of life. Mr C reported that the Hospice helped him come to terms with his illness and that he felt supported and cared for. Mrs D reported that she now uses less oxygen since St Luke’s Specialist Physiotherapist Service team have taught her how to manage her shortness of breath. This work consolidates the Hospice commitment to ensuring accessibility to high quality care for people with advanced long term conditions. Building on the findings from previous projects, plans are underway to develop a similar pathway for people with end stage kidney disease with funding being sought to support this work. The Heart Failure Clinical Nurse Practitioner will play a key role in this work becoming the Hospice CNP for Long Term Conditions. The Hospice works to widen access to services for people with Dementia and will continue with monthly social drop ins for people with Dementia and their carers (this is run jointly with the Admiral Nurse from BTUH). The Hospice will be embedding its profile as a dementia friendly organisation and continuing the training and development of Dementia Champions within teams. A support group for patients with long term conditions is now established and is well attended by the patients and their carers who are on the project.

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Priority Two: Enhancing and extending the Frailty and Care Homes Palliative Support Service (FCHPSS) The Frailty and Care Homes Palliative Support Service has been enhanced and extended during 2018/19 building on the good work and outcomes achieved since Service set up. This has included 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 for patients on the FCHPSS caseload (visits and via phone) and patient visits when patient requires Advance Care Planning. In addition, the team has developed two projects. One looking at care home work broadly throughout Basildon and Brentwood (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 Care) in Thurrock. Achievement’s since the Service began in January 2017:

FCHPSS have had 1605 Referrals since January 2017 (up to December 2018)

Of all these referrals there has been only one patient that the Service was unable to manage in the community, the only time a patient has been admitted to hospital from the Service

Managed 493 Hospital Discharges to Care Homes

FCHPSS have facilitated or requested 275 ‘preferred place of death conversations’

91% of patients that died whilst on the caseload achieved their PPD, the remaining 9% did not yet have a recorded PPD

99% of patients that died whilst on the caseload, died in their Care Home.

Only one Patient died in hospital whilst on the caseload- as their GP thought they had an acute reversible illness

3257 phone calls, 469 Patient face-to-face visits

The average number of 999 calls from Care Homes is now 94 per month, compared to 172 Care Home A&E attendances in 2015

Service Structure:

Head of Hospice Community Services

FCHPSS CNP/Team Lead/Nurse Prescriber OneResponse

Senior Nurse—Leading TH Project

Senior Nurse—Leading BB Project

HCA (10 hours per week)

HCA (10 hours per week)

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Priority 3: Development of Stronger Partnerships The Hospice has continued to build on our Lead Provider role to embed and develop the significant partnerships that have emerged with other providers and the Clinical Commissioning Groups (CCG’s). We have worked 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 our locality. St. Luke’s Hospice are proud of its commitments to partnership, integrated working. Throughout 2018/19, this has included:

Delivering fully integrated Hospice Community Services with SPDNS and Marie Curie, working wherever possible as one team- liaising with them closely over their new electronic database and including their staff in planned improvements to allocation of visits by the Hospice Community Services team

Providing over 400 night visits per quarter and 1617 Rapid Response visits from April 2018-March 2019 through OneResponse.

Worked with SFH delivering elements of care in Brentwood, including Care Homes

Developed forums to allow discussion and agreement about care delivery and improved pathways such as:

- Care Home Managers: This meeting is held Bi-Monthly and chaired by CNP/FCHPPS Lead. All 36 Care Home Managers covered by the Frailty & Care Home Palliative Support (F&CHPS) Service are invited to St Luke’s. The purpose is to update the managers with the Service’s data collection and analysis, themes and trends with regard to 999 and 111 call data, as well as the results of the BTUH Care Home RIP audit. We reflect on things that could have gone better and share good practices and ideas of how we can improve our level of care going forward. The feedback from these meetings have been consistently positive. The main challenge for the managers is making space in their busy workday to come to the meeting, however most do send a representative from their home when they themselves cannot attend. From this meeting, we have previously worked together in creating a pathway for Residential Homes to gain an emergency supply of incontinence pads when a patient is at the end of life to ease the stresses this normally generates. FCHPSS have also teamed up with BTUH Trusted Assessor from the BTUH Complex Case Management Team. She has come to a number of these meetings to talk about the Red Bag Scheme roll out and also about how we can all improve the journey to, around and from hospital when a Care Home Resident needs to be admitted. This was very beneficial, as by working together and bridging the gap between primary and secondary care, we can ensure the patient has everything they need to be taken to hospital, triaged in A&E, moved to a ward before being discharged back to their home, with all professionals aware of their own responsibilities contributing to the safe and effective patient journey.

- Brentwood Partnership: To improve the joint working bi monthly meeting are arranged in Brentwood Community Hospital. Saint Francis Hospice, Queens Hospital, the Integrated Care Team (ICT) and Single Point of Referral (SPOR) representation are invited. There is a set agenda and because Hospice Community Services now have the use of a Brentwood Community Hospital (BCH) office we are able to access SystmOne to discuss mutual patients. The ICT are based at BCH so it is easy for them to join the meeting. The RADS team attend the meeting to reflect the increasing number of patients who meet the fast track criteria that RADS care for. Each meeting has been audited and a proforma which is easy to read and links to a proactive Action Log is generated from these meetings.

- Community Services Meeting: these are meetings generated by Hospice Community Services to liaise and communicate with the Integrated Care Teams and the rapid response Services - RRAS and SPOR. Also invited are SPA and Thurrock First. This has enabled clearer pathways in communicating with each other to avoid patients getting missed. It is best for palliative patients to ring OneResponse first as a single point of contact because it is staffed 24/7 and has access to

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clinical advice very quickly. However, some of the calls are triaged out to the community nursing teams and we have now identified the best way to do this. The Hospice Community Services team constantly asks to talk to community nurses and so we run meetings for each team - Basildon and Billericay and Thurrock to help this. For example, at the meeting in March 2019, it was agreed for the ICT to ring into OneResponse daily if possible to discuss mutual patients. It was also agreed to task the ICT every time we see a patient at home, so there is no chance of them being left out of the loop. Again the meetings have been audited as essential and ongoing, and generate an action plan - part of which is encouraging placements within each other's Services.

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Sustainability and Transformation Plan (STP) The Purpose of the Sustainability and Transformation Plan End of Life Care Programme Board is to ensure and support progress against the End of Life Care Programme objectives, this includes:

Provide accountability, challenge and assurance of programme delivery

Ensure coherence and a common sense of direction across the STP work streams

Identify where further work, within or across individual work streams might be needed to achieve the government’s response to the Choice Review, NHS Mandate and Ambitions for Palliative and End of Life Care: A national framework local action 2015-2020, and to commission work accordingly

Identify synergies between individual projects and recommend changed or additional deliverables to ensure we operate effectively across the whole system with localism built in where needed to ensure the needs of local people can be met Identify and manage high-level risks to delivery

The Hospice will continue to attend the STP End of Life Care care group and support completion of the work plan including the roll out of the PeACE and IAM documents. The Hospice Quality and Education Service will be instrumental in providing support and education around these initiatives across the locality. The Hospice also now has a representative on the STP Cancer Board.

“Amazing, caring, empathetic, patient devoted, family-like staff”

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Statements of Assurance from the Board Review of Services - During 2018/19 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 (Clinical Nurse Specialist in Palliative Care/End of Life Care Facilitators) Specialist Occupational Therapy Service 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 The Hospice has reviewed all the data available to them on the ‘quality of care’ in all of these Services. The income generated by the NHS Services reviewed in 2018/19 represents 48% of the total income generated from the provision of NHS Services by St Luke’s Hospice for the reporting period 2018/19. 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 2018/19. 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.

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Participation in Clinical Audits and Research Audit Quality Report 2018-2019 External Audits Completed External Education Audit Anglia Ruskin University and the University of Essex completed a Practice Education Audit of St Luke’s Hospice. The audit reviewed student contacts, types of placement and the placement profile. This audit did not identify any ongoing actions. The audit detailed the remit for students. National Comparative Audit of Red Blood Cell Transfusion in Hospices The audit aimed to determine current transfusion practice and outcomes in hospice palliative care and to make recommendations to improve future clinical care. The data for this audit was collected from September-December 2016 thus completing stage one. External Infection Control In September 2018 an external Infection Control Audit was conducted to ensure the Organisation continues to maintain a high standard of Infection Control. The modules completed within the audit were: Hand Hygiene Environment Kitchen Waste Disposal Handling and Disposal of Linen Management of Spillages and Blood/Body Fluid Personal Protective Equipment Safe Handling and Disposal of Sharps Specimen Handling Management of Patient Equipment (General) Evidence of quality care and best practice The Hospice was found to be compliant with 99% compliance achieved. The general environment of the Hospice was clean and odourless. The equipment and other materials seen in use were found to be clean and in a good state. The reception staff were observed to be reminding and encouraging visitors to use hand rubs at the entrance of the Hospice. The two small areas found to have issues were brought to the attention of the infection control team who have implemented the necessary corrections. One off Audits – Bisphosphonates Bisphosphonates are a group of medications that affect bone metabolism. The intravenous Bisphosphonate currently used at St Luke’s Hospice is Zoledronic Acid (Zometa). This medication is associated with rare but potentially serious side-effects, so it is vital that appropriate monitoring and regular treatment reviews are completed. The Hospice has provided an Outpatient service delivering intravenous infusions for over 12 years and the service has been audited twice previously. There have been changes in the service provision, and an increased number of referrals which have led to a re-audit with a view to updating the current policy guidance and documentation required. The data collection reviewed all new referrals received between April 2017 and March 2018. There have been clear improvements in all areas of the management and monitoring of patients attending for intravenous Bisphosphonates since the last audit in 2012. There have also been changes in practice, new medications and new NICE guidance since the last audit to support changes. The following action plan is being worked through.

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A new policy and guidance document will be written, including pathways which will enable appropriately trained nurses to run the infusion clinic. The SystmOne templates will be updated to ensure that the appropriate assessment and monitoring is carried out. Clear treatment plans and reviews will be made in conjunction with the referring Consultants. Standard electronic letters to GPs, Dentists and referrers will be developed to ensure appropriate information sharing. Nursing staff and medical staff will be informed of the above and trained as necessary. Internal Audits Completed Hospice UK Audit Day Hospice Hospice UK Infection Control Modules 1- Policies & Protocols Hospice UK Infection Control Modules 2 Hand Hygiene Hospice UK Infection Control Module 3- Patient Areas Hospice UK Infection Control Module 5- Patient Bathrooms Hospice UK Infection Control Module 6 Patient Toilets Hospice UK Infection Control Module 7 Sluice / Dirty Utility Hospice UK Infection Control Module 8 Domestic Rooms Hospice UK Infection Control Module 9 Care of Deceased & Module 16- Visitors Accommodation Hospice UK Infection Control Module 14 Toilet for Public Areas Hospice UK Infection Control Module 12 Kitchen Areas Hospice UK Inpatient Admission Audit Hospice UK Nutrition Audit Hospice UK Pain Management Audit Tool (Post Work) Annual Audit Review Assessment for Patient Self Administrations of Medicines Carers Support Needs Assessment Tool (CSNAT) Audit Collaborative Peer Review Complaints Management Process Review over the last three years. CPR Decisions Audit Data Protection Falls Audit Hospice Community Services Nutrition Audit Information & Communication Audit Information Governance Inpatient Unit Discharge Medication List Audit Management & Safe Handling of Medication Unit Medicine Management Audit Incorporating Management & Safe Handling of Storage Medication Unit Medicines Management Review Nurse VOED Audit Pressure Ulcer Audit RADS Social Care Team Audit Re-audit of pain management on IPU Record Keeping OACC Process Day Hospice x 2 Sample Visible ID Audit Subjects Requested on a study day (awaiting report) Syringe Driver Use Audit Quarterly (2 Quarters Completed, 2 in progress). Use of Homely Remedies Audit Use of Verbal Orders Audit VTE Prophylaxis Audit 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. The team felt committed to embedding this tool and have worked to build it in SystmOne and have also looked at a less acute focussed triage tool and added some more very end of life care questions into it. Once medical approval has been received it will be rolled out and audited.

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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 Care 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.

Satisfaction Surveys Dove Community Counselling Service Client (all Clients) Satisfaction Survey Dove Community Counselling Service Supervision, Support, Education and Communication of Counsellors Placements Luke’s Adult Group and Child Group Satisfaction Survey Luke’s Counselling & Support Children & young People Staff Survey for Education, Training and Supervision (Organisation wide) Volunteer Satisfaction survey Currently IPU, DH IRS, CPCT, OneResponse and Physiotherapy and SELS are trialling a 5x5 Service user feedback questionnaire which replaces the satisfaction surveys which these teams have previously conducted. 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. 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. The 5 x 5 surveys are working well. A summary for each department is planned for the year. Comments include:- ‘I am extremely grateful for all your support’. ‘Completed Exceeded Expectations, couldn’t cope without’ ‘Treated with care and dignity.” ‘All services wonderful – thank you.’ ‘Excellent, the whole process from referral to placement’. ‘Changed thoughts of Hospice’.

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What the CQC Said About Us:

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. 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."

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“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.” “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." 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.

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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 April 2019), 314 verifications of expected deaths have been carried out by Registered Nurses who have been trained and assessed as competent, 94% were known to Hospice Community Services (64% have been carried out in out of hours)

To date (31st April 2019), all Surgeries have signed up to VOED in some capacity Key Achievements - Frailty and Care Homes Palliative Support Service

• There has been a 106% increase in referrals for the service from 2017/18 to 2018/19, and 84% of patients achieved their PPC/D.

• The number of patients admitted to Hospital whilst on caseload by CNP still remains at 0. NHS Number and General Medical Practice Code Validity St Luke’s Hospice did not submit records during 2018/19 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 entry level. Clinical Coding Error Rate St Luke’s Hospice was not subject to the Payment by Results clinical coding audit during 2018/19 by the Audit Commission.

“I cannot praise nor thank the staff enough for the way in which they

have looked after me over the last week. Every member of staff have

been helpful, professional and willing to assist. Thank you again for

everyone who made me feel welcome”

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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 was to provide confidence to the public and patients to make informed choices. The accreditation allowed 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 annually thereafter. NHS England now host the Information Standard and information on the future re-accreditation process is awaited. Implementing a robust process of clinical information for patients. Although the Information Standard is no longer hosted by NHS England, best practice principles of information development remain embedded across the Hospice. 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 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 importance 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. The Trustees have reviewed the structure and format of the visits to further enhance the experience and use of this process. 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 Hospice was 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.

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 and therefore set up a Task and Finish Group for this

purpose. Members are co-opted as required and the group reconvenes when appropriate to look at our

patient safety and any new regulations. The group provides feedback through the Strategic Quality Steering

Group and Monitoring of Incidents Committee, with some change to processes already introduced.

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Staff Satisfaction Survey The last staff satisfaction survey had these results:

100% of participants recommended the Hospice as a good place to work

The comments on aspects of their job that staff particularly like are very positive, heart-warming and varied

The communication ratings were much better compared to the previous year which was a positive validation of the additional communication throughout the year.

Finally there were some extremely positive and heartfelt comments made about how staff feel about their jobs and working at the Hospice generally

Comments from the survey included:

“St Luke’s is fair, flexible and always understanding and maybe sometimes we take for granted how well we are treated and supported”

“I would recommend St Luke’s as an employer”

“We are all very lucky to work here”

“I feel extremely lucky to have such a wonderful supportive Manager and team to work with who are all open and approachable”

“Excellent study training which is practical and appropriate to work situations, which is a very effective use of staffs’ time”

“Over the years the job has developed and I have been given the resources, support and training to manage the changes”

“Feeling what I help provide within the team can make a difference not only to patients and families but also for staff and visitors. Working in a fantastic team and with genuinely lovely people”

“My department is well-organised and smooth running”

“The team are friendly and very supportive. I feel my role is appreciated by them”

“My role is the perfect job for me and feel privileged to be able to be in the post”

“Really appreciate the support and flexibility from my Manager, I feel very lucky to work here”

“I feel very privileged every day to meet the people that I meet, and to be a small part of their lives”

“I enjoy my role and feel very supported in the role”

“I’m soaking up every opportunity and enjoying my role” From 2019 the Hospice will be looking at a new external survey so we can benchmark against similar organisations.

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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.

“I feel extremely privileged to have had a period of respite and assessment in this fantastic facility. The care and attention to detail are second to none. It is clear that from the manager in charge to the many volunteers, the staff really care for and about each other as well as the patients. It is an extremely nurturing environment. When there is a death, a frequent occurrence here, a whole team of experts slip effortlessly into their various roles providing effective support for all members of the family. I cannot think of any possible improvements and extend my grateful thanks to all the staff.” “Amazing, caring, empathetic, patient devoted, family-like staff - even the domestics! “I would like to say how grateful I am for the care and treatment I received here in this unit. The staff could not have been more kind or helpful. When my time comes for me to go, this is the place I want to be. What really kind and wonderful people you have here. Thank you.” “I was very well looked after, staff were helpful, I liked the relaxed atmosphere and the fact you can eat whenever you like. Carers at home have been wonderful and made me laugh! “I cannot praise nor thank the staff enough for the way in which they have looked after me over the last week. Every member of staff have been helpful, professional and willing to assist. The Unit itself is clean and well supplied with equipment again making my stay easier. Thank you again for everyone who made me feel welcome.” “Brilliant Service, can’t fault it. No bad, all good.” “Outpatients have been our saving grace.” “It’s like home from home.” “Very lovely staff, made to feel very welcome.” “Staff always friendly and helpful.” “Once you get your referral to Day Hospice, everything just falls into place.” “All helpful and supportive.” “I was in a tunnel with no way out, except for one! I do believe if it was not for my counsellor I surely would have taken that option just to be with my wife again. Now there is a small light and I hope I can face up to my late wife’s hopes and desires. Thank you so very much for being my lovely counsellor” “I sincerely felt I was paired with an extremely good therapist. My counsellor was very understanding and has helped me work through a lot in such a short time. I cannot even express how grateful I am.” “I cannot tell you how much talking to my counsellor has helped me. I had no-one to talk to as I felt I had to be the strong one to support everyone else but I was crumbling inside. Talking to my counsellor I have come to realise that I have to heal myself and take time for me before supporting others. She has helped me get my old self back and I cannot thank her enough for listening” “I was able to confide in my counsellor so easily and she helped me so much. For the way she listened and advised I am very grateful for my sessions with her. Thank you” “I felt fully supported by my counsellor in my sessions. I felt she listened and understood how I was feeling. I could open up to her about everything and I would recommend the Service to others if needed.”

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Review of Quality Performance April to March 2018/2019 Hospice Community Services Other Hospice Support Services In-Patient Unit, Day Hospice and Out-Patients

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

and end of life care needs leading to 1,613 avoided hospital admissions (an increase of

2.2%), of which 1,306 were during the “out of hours” period (an increase of 9.9%)

Our Frailty and Care Homes Palliative Support Service received 1327 referrals during the year – an increase of 89.8%

Hospice at Home received 872 new

referrals, an increase of 2.2%

OneResponse received 38,760 incoming

calls (an increase of 20%) Of these, 15,565 were referrals/

episodes of care

The Rapid Assessment and Discharge Service (Fast Track Care) received 587 referrals and delivered 17,000 hours of

care (an increase of 4.6%)

The Information Resource Service had 2,783 face to face enquiries and made

5,256 actions on enquiries

The Community Palliative Care Team

received 1376 referrals

The South Essex Lymphoedema Service received 536 referrals which is

an increase of 32% compared to the previous year and there were 1,885 clinic

attendances/face to face contacts

The Specialist Physiotherapy Service received 343 referrals

and supported 1,878 patients through face to face and group contact

Lukes Counselling Service for Children and Young People received 168 referrals supporting 229 children, a 24.5% increase compared to the previous year. 43 groups were run through the year – 7.5% increase

from the previous year.

Dove Community Counselling (our adult

counselling Service) received 1,628

referrals and carried out 2,729 face to face sessions

Our Social Work Service received 230 new referrals and our

Carers Support Service received 370

referrals, an increase of 8.8% There were 204 admissions to the

In-Patient Unit. 98.6% of those admitted achieved

their Preferred Place of Care (PPC) Our Day Hospice received 300

referrals with an annual attendance of

2,350 visits, an increase of 17.1%. There were 673 attendances at

Out-Patient Clinics,

an increase of 7.5%

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NHS BASILDON & BRENTWOOD CLINICAL COMMISSIONING GROUP’S COMMENTARY ON ST

LUKE'S HOSPICE 2018/19 QUALITY ACCOUNT

NHS Basildon & Brentwood Clinical Commissioning Group (BB CCG) welcomes the opportunity to

comment on the annual Quality Account prepared by St Luke's Hospice as commissioner of the service.

To the best of NHS BB 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 BB CCG notes the progress against the priorities identified for 2017 /18.

The first priority was the award winning pioneering project for the collaborative approach to the care of

patients with Advanced Liver Disease being extended to people with other long term conditions; specifically

the development of the Heart Failure Pathway through the Heart Failure Clinical Nurse Practitioners (CNP)

Grant which has been running for almost one year. The BB CCG is also pleased to recognise the

development of the IV furosemide pathway and that early qualitative feedback has shown a definitive

improvement in quality of life. The BB CCG also notes the plans to develop a similar pathway for people

with end stage kidney disease. The BB CCG commends the work being undertaken by the hospice to

widen access to services for people with dementia and the continuity of monthly social drop-ins, together

with the continuing training and development of dementia champions. The addition of a well-attended

support group for patients with long term conditions is welcomed.

The BB CCG commends the achievements relating to the second priority which was to enhance and

extend the Frailty and Care Homes Palliative Support Service (FCHPSS) noting particularly that of the 1605

referrals since the project began there has been only one patient that the Service was unable to manage in

the community. Further commending the achievement of 99% of patients that died whilst on the caseload,

dying in their place of residence (Care Home).

The BB CCG also notes the further work to develop stronger partnerships as detailed with Priority 3,

particularly the establishment of appropriate forums to allow discussion and agreement relating to care

delivery and improved pathways and across the Sustainability and Transformation Plan (STP).

The BB CCG notes the participation in clinical audits and research, specifically the recommendations and

actions from the End of Life Care Audit. It also acknowledges the clinical quality innovations achieved.

The BB CCG notes the outcome of the last Care Quality Commissions (CQC) visit culminating in achieving

an “Outstanding” rating

PRIORITIES FOR 2019/20

The BB CCG is pleased to note that the Hospice has identified the following priorities for improvement:

Priority One: Continuation of Heart Failure Pathway through the Heart Failure Clinical Nurse Practitioner

(CNP) Grant

Priority Two: Extending the Frailty and Care Homes Palliative Support Service (FCHPSS)

Priority Three: End of Life Register - Development of Stronger Working Partnerships

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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 positive patient feedback.

NHS BB 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.

Teresa Kearney

Chief Nurse, Basildon & Brentwood CCG

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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 was the award winning pioneering project for the collaborative approach to the care of patients with Advanced Liver Disease being extended to people with other long term conditions; specifically the development of the Heart Failure Pathway through the Heart Failure Clinical Nurse Practitioners (CNP) Grant which has been running for almost one year. The CCG is also pleased to recognise the development of the IV furosemide pathway and that early qualitative feedback has shown a definitive improvement in quality of life. The CCG also notes the plans to develop a similar pathway for people with end stage kidney disease. The CCG commends the work being undertaken by the hospice to widen access to services for people with dementia and the continuity of monthly social drop-ins, together with the continuing training and development of dementia champions. The CCG commends the achievements relating to the second priority which was to enhance and extend the Frailty and Care Homes Palliative Support Service (FCHPSS) noting particularly that of the 1605 referrals since the project began there has been only one patient that the Service was unable to manage in the community. The CCG also notes the further work to develop stronger partnerships as detailed with Priority 3, particularly the establishment of appropriate forums to allow discussion and agreement relating to care delivery and improved pathways and across the STP. The CCG notes the participation in clinical audits and research, specifically the recommendations and actions from the End of Life Care Audit. It also acknowledges the clinical quality innovations achieved. Priorities for 2018/19 The CCG is pleased to note that the Hospice has identified the following priorities for improvement: Priority One: Continuation of Heart Failure Pathway through the Heart Failure Clinical Nurse Practitioner (CNP) Grant Priority Two: Extending the Frailty and Care Homes Palliative Support Service (FCHPSS) Priority Three: End of Life Register - Development of Stronger Working Partnerships 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 positive 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 Essex 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. It is excellent to see 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. HW Essex is assured by the three main priorities which includes;

The Liver & heart project, extending the frailty and care home palliative support service and work around the end of life register.

It is reassuring that the three priorities are based on ever growing partnerships and whole system thinking.

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 still clearly a system leader around liver disease and nurse training which is so important in the workforce planning. I am assured that over the least 12 months recognition of the workforce issue is still a major issue.

HW Essex is pleased so many kind statements of support from patient, carers and family members. 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 25th June 2019