QUALITY ACCOUNT - assets.nhs.uk · Natasha didn’t feel ready for Hospice care. “I come from South Africa and there a Hospice is a building where you go and don’t come home again

QUALITY ACCOUNT

Year ending 31st March 2018

We supported 1,555 patients and

their families in 2017-2018, an

increase from 1,379 in 2016-2017.

TOGETHER WE CARE

QUALITY ACCOUNT 17/18QA V3 KH/EP 2018 2

OUR VISION

Communities talk openly about death and dying, everyone lives life to the full and dies with dignity in the place of their choice knowing their loved ones are supported.

This new vision was formed out of our frustrations at the lack of conversations about living well and dying well and at the last minute referrals we so often receive meaning we can only care for people for a few days or weeks when our experience shows we can help people live well for longer if they receive our support. We also believe that for every 2 people we support there is a third person who could benefit from our care – that’s up to another 700 people every year. So, after many months of work reviewing the environment in which we are operating, key strategies for the local CCG (Clinical Commissioning Group) and the wider STP (Sustainability and Transformation Plan), a Health needs Assessment we had jointly commissioned with Garden House Hospice, and National Ambitions for End of Life Care, we have agreed 4 key strategic themes which will drive everything we do in the coming years:

1. We aim to support and care for More people

2. Reach people Earlier - enable them to live as well as possible for longer

3. Educate – to share and leverage our expertise

4. Collaborate and build partnerships – to deliver effectively

This is an exciting time for Isabel Hospice as we build on and extend the excellent work done over so many years, to reach more people, earlier in their illness as we seek to achieve our new vision.

A PATIENT’S STORY

Natasha

When Natasha (42) was told by her Lung Specialist Nurse at The Royal Brompton that she had been rejected for a lung transplant and that there was nothing else they could do for her, she recommended that Natasha be referred to Isabel Hospice. Natasha didn’t feel ready for Hospice care.

“I come from South Africa and there a Hospice is a building where you go and don’t come home again. I said “I’m not there yet!”, but my nurse explained to me that wasn’t what palliative care was about, and so, with trepidation, I thought I’d try it. In May I got an appointment to come to the Hospice’s Living Well session on a Thursday in Thorley, which is near my home in Bishop’s Stortford and I drove myself there.

That first day I was so nervous. I felt terrified. I tried everything to get someone to come with me, but no one could come. So I thought, I need to put my big girl pants on and come! I took those first steps into the building on my own and I am now so glad I did. The place itself is incredible. A high ceiling with beautiful beams. It has a special feel about it. The staff and volunteers are so wonderful. I come here and talk, I do artwork and have reflexology which is just amazing for me, I find it really helps. I also do exercise here, as at home I have a wheelchair now and don’t get much exercise. I have a little dog, which I

MAYJUNEJULY

1.More 2.Earlier 3.Educate 4.Collaborate


got when I became ill. She keeps me company when my husband is at work and I love having her. On the Thursdays I don’t come to the Hospice, my husband can see my mood is low. Coming to Thorley really lifts me.

Deborah, the art therapist has been helping me with writing letters and making memory boxes. I came here so fearful, and now I have friends. It’s helping me along the path and I know that when the time comes, I have already relationships I can rely on.”

CHIEF EXECUTIVE’S STATEMENT

I am delighted to share with you our Quality Account for the year to 31 March 2018. You’ve already read our compelling vision and an overview of our key strategic aims - to support more people, earlier in their illness - and this report outlines some of the ways in which we are working to achieve this.

We’ve supported more people than ever before in the last year, and as you will see from the significant work underway we aim to increase this further in the coming years by removing barriers to access, building more partnerships and by targeting people with particular illnesses who we know are less likely to access hospice care. We’ve been open and honest in sharing feedback from complaints, which we’ve used to improve services - and the actions we’ve taken where we’ve identified learnings from audits. We are a learning organisation and feedback from the patients and families we support and care for is invaluable as we strive to improve their experience.

I hope you find this report informative – and as with everything we do if you have any questions or suggestions as to how we could improve it please do let me know.

Robin Webb Chief Executive

1. KEY PRIORITIES FOR 2018-2019

1.1 Introduce new models of care – with a focus on earlier referrals to reach more people

We estimate there are around 700 local people a year who are not accessing hospice care who may need it now. The greatest unmet need is for those wanting to be cared for, and die at home. As part of our clinical strategy, we aim to provide earlier, more efficient and direct access for patients with life limiting illnesses in our community. We will achieve this via a number of exciting projects:

• Build an integrated health community by working in and with the community. We want to engage people who may benefit from our services but who still see a hospice as a building with beds. By expanding our nurse led clinics in three critical locations we aim to enable patients to access our specialist care earlier whilst remaining independent and proactive.

• Encourage more referrals by extending our Living Well services to offer more programmes in a variety of locations closer to where people live. We will offer easy access for those who would like to join without a referral to further break down barriers.

• Strengthen our relationships with General Practitioners and palliative care teams in acute trusts to encourage earlier referrals. Our dedicated Heart Failure CNS will be attending Multi-disciplinary team meetings at Lister Hospital, QE11 and Princess Alexandra Hospital in Harlow. This will be complemented by our increasing Day Service (Living Well with Isabel) provision, particularly our Fatigue and Breathlessness groups. These courses will be taking place across our day service locations and GPs will be able to refer directly without the patient having to access our wider hospice services.


• Increase in Hospice at Home nurses providing night service – patient experience feedback shows us that some of the hardest times end of life patients and their carers face is being at home alone during the night. Building on our successful Hospice at Home service we will be providing night service over 7 nights with the aim of caring for 100 more patients.

• Using Outcome Assessment Complexity Collaborative (OACC) data to help shape our community service. By extracting the appropriate data, we will be able to manage our community caseloads effectively; determining which patients require earlier active interventions and those who require a multi-disciplinary approach.

1.2 More support for carers by working in collaboration

Caring for a loved one with a life limiting illness can be an important and fulfilling time where bonds between people are strengthened. However, carers may also require support to deal with the strains and worries that illness can bring.

The Carer’s Support Needs Analysis Tool (CSNAT) is an evidence-based tool that facilitates support for family members and friends (carers) of adults with life-limiting conditions. We aim to introduce this tool so that it is widely used across our clinical services. This will enable us to identify and provide signposting for loved ones caring for our patients.

Our collaborative work with Carers in Herts continues, hosting both the ‘Caring with confidence’ and ‘Creative Writing online’ courses at the Living well with Isabel Community Hub in 2017. A member of the educational team and our Complementary Therapist provides support and advice to Carers in Herts community hubs. During this visit, the work of the hospice is explained highlighting support for non-cancers patients and living well services. A practical session on simple hand massage is given and always proves popular. In addition, links with the Alzheimer’s association and local Dementia Action alliances continues to provide collaborative support for carers.

1.3 Through education and collaboration - empower our communities

We know that we cannot take ownership for all the people in our area with life-limiting illnesses. Therefore, we aim to provide healthcare professionals, patients and their families with the knowledge, skills and confidence to engage with palliative care and to start talking openly about death and dying.

The expansion of our Community Hub at Hall Grove in Welwyn Garden City, will enable us to extend our external education programme to all healthcare professionals involved in palliative care. A learning zone has been created to provide education for all within the working day. We are also working to ensure awareness of inequalities in palliative care. Therefore, alongside learning disabilities and dementia education, which we already deliver, we have now created study days on mental health and palliative care and have added LGBT to our learning zone. Connecting with homelessness charities is vital to ensure they understand the support our service can provide and we are working towards this. Alongside the above, further study days have been added for the forthcoming education programme, to include heart failure and pressure area and skin care, bereavement training for schools (which was so popular we have had to add extra days), alongside the extensive education programme we already deliver. We are also reaching out to our informal carers and the public to reinforce our living well ethos and create opportunity for conversations on end of life care. We know the demand for palliative education is high and we aim to be responsive to our community’s training needs thus ensuring that our patients get the best care they possibly can.

• Compassionate Neighbours is an award winning, free community-led project for anyone living with a chronic, long-term or terminal illness and experiencing loneliness or social isolation. Building on our clinical strategy to reach out to people within our community, we will be working jointly with St Clare Hospice in Harlow and Garden House Hospice in Letchworth to implement the Compassionate Neighbours programme.

• Plan for increasing the availability of bereavement support, targeting areas of priority need through the use of bereavement cafes. This will be done across three sites throughout eastern Hertfordshire, Welwyn, Cheshunt and Bishop’s Stortford. Service users will be able to access helpful materials and it will serve as a forum for sharing experiences and learning


• Introduce a care home Clinical Nurse Specialist facilitator role. This pilot role will work alongside and in 4 care homes in eastern Hertfordshire, providing specialist knowledge to the staff working in these homes and helping to embed education. Referrals can be considered from the care home, GP or family. The nurse will attend ward rounds in the home with the General Practitioner and the home staff. This will lead to earlier identification of specialist palliative need and greater collaborative working to enhance end of life care for those without specialist need.

1.4 Collaboration with patients, carers and the public with personal experience (PPE) in palliative care and end of life care services

Patient experience has always been an important focus to help make improvements to our existing service. However, user involvement is sometimes difficult with people nearing the end of life.

We will be looking to work towards a cross-organisation engagement with people with personal experience with the aim of this impacting our service delivery. The groups will include patients, volunteers, clinical staff, non-clinical staff and the wider community at different levels and across different settings. The aim is to be able to demonstrate changes to practice and improvement to quality through the feedback received.

2. REVIEW OF PRIORITIES DURING 2017-2018

2.1 Improving Access

• Non-cancer patients

The traditional view of a hospice, and one which is still held by many people, is about providing care for patients with a cancer diagnosis. However, the number of patients living with long term multi-morbidities is increasing and therefore the demand to provide high quality palliative care for patients with non-cancer conditions is growing.

Our clinical team has worked hard this year to bridge the gap and provide much needed specialist palliative care for such patients.

Referrals for non-cancer patients accounted for 32% of all referrals to our service last year, with 40% achieved in March 2018. The table below shows the increase year on year.

500

450

400

350

300

250

200

150

100

50

0

Non-cancer referrals into Isabel Hospice

2013-2014 2014-2015 2015-2016 2016-2017 2017-2018


This has been achieved through:

• Heart Failure Specialist Nurse creating links with the Heart Failure Teams at our local acute trusts to encourage early referral

• Development of specialist Neuro group facilitated by Medical Consultant and attended by Specialist Neurological clinicians from across East and North Herts

• Education for primary care services around our provision of care for non-cancer patients

• Expansion of our Day Service Groups to include specialist courses for patients with life limiting lung conditions

• Expansion of Day Service – Living Well with Isabel

At the start of last year, we were given the opportunity to lease a large building which adjoined our Hall Grove Day services. We wanted to use this opportunity to expand our service provision and meet the requirements of patients and their families living with a wide variety of long term conditions earlier in their journeys.

Our nurse led full day sessions took place every week in two localities across our area, Welwyn Garden City (Hall Grove) and Thorley (Bishop’s Stortford) alongside a therapy led Feel Good session of exercise and relaxation at the Nigel Copping Centre (Stanstead Abbotts). With the increased space we have also run the following courses, groups and sessions:

• Fatigue and Breathlessness Course

• Coping Well Course

• Falls Prevention Course

• Neurological Support Group

• Feel Good Friday/Monday Exercise and Relaxation groups.

• Feel Good Singing sessions–

• Tai Chai / Qi Gong sessions–

• Craft Cafe –Social Drop In sessions

We have also welcomed several community health groups to use the hub facilities as collaborative support for the community.

This has led to Living Well attendances increasing from 1267 to 4227, an increase of over 200%. The number of patients attending these Living Well with Isabel sessions has increased from 139 to 224. Increasingly the patients attending have a wider variety of serious long term conditions such as Chronic Obstructive Pulmonary Disorder COPD (30%) heart failure (18%) and neurological conditions (10%). Some of these patients have also gone on to access our specialist palliative care services.

This development has proved to be hugely successful and beneficial for our community patients.

2.2 Health Needs Analysis

A population based needs assessment was requested by East & North Hertfordshire Clinical Commissioning Group (E&N Herts CCG) and commissioned by the Garden House Hospice Care and Isabel Hospice. The fundamental aim of this Health Needs Assessment is to provide an overview of the healthcare needs of adults nearing the end of life within the E&N Herts CCG region. This assessment is based on an analysis of the population living within the region and the current provision of services in relation to palliative and end of life care.

This assessment is the result of analysing the information provided by those commissioning the report and by information publicly available. This report does not aim to establish a specific way to develop new services or to improve the existing ones. The intention is to support the development and improvement of such services. At Isabel Hospice we have integrated the findings of the report into service development and the development of our overall strategy


2.3 Improving Access to patient related communication

On 1st July 2017, Isabel Hospice adopted a new electronic record keeping system called SystmOne. This system is used by the vast majority of local General Practices, urgent care services and district nursing teams and allows for the sharing of clinical patient information, in line with patient consent.

The benefits of the implementation of this system have been immediate. With a robust information governance process in place ensuring that we provide patients with written information about how we will share their information and requesting consent to do so, we are able to immediately view and share critical health information with other healthcare professionals involved in the patient’s care.

This encourages safe, effective and collaborative care and ensures that at each contact with the patient, our healthcare professionals have access to the most up to date information. Patients are not expected to repeat historical information but rather we can focus on working together to create and implement an individualised plan of care. It has proved to be particularly beneficial for those patients whom require a rapid response from our hospice at home team.

2.4 Palliative Education Programme

We delivered a diverse internal and external education programme during 2017/18. The majority of our Statutory Mandatory training was delivered as e-learning for the first time. This proved to be popular as it was both efficient and flexible for clinical staff to complete. We also delivered a number of professional development programmes, a number in collaboration with palliative care providers across our locality.

The table below shows our training attendance figures:

Training figures for April 2017 - March 2018

Training Type Total Number of Sessions Total Number Attended

Bespoke Training 1 2

Clinical Professional Development 49 352

Delivered Externally to other Organisations

13 112

External Education Programme 28 427

Placement at the Hospice (does not include Student Nurse)

1 6

Stat/Man 40 318

Volunteer Training 13 171

Total number of sessions: 145

2.5 Clinical Data Reporting

Data collection is a standard activity for all palliative healthcare services but we have worked to use that data to really understand the service that we provide, help target service delivery and assist the development of a clinical strategy to enhance care provision.

At the start of the year, we undertook a full review of historical data for gaps in service provision. The analysis showed patients often being referred to our service late in their diagnosis and that that only 19% of referrals were for non-cancer patients. Together with the Health Needs Analysis of our population, it was clear that there was a gap in early specialist intervention for our diverse palliative service user population. This identification of meaningful data collected helped to inform Hospice strategy and vision of supporting more people earlier and plan to introduce the new models of care as detailed in section 1.1.

With Outcome Assessment and Complexity Collaborative (OACC) measures now fully embedded in clinical practice, we also wanted to understand how these patient reported outcomes could be used to improve patient care. We introduced a daily morning community meeting to identify and discuss those patients with an unstable phase of illness with a focus on providing support for these patients, ensuring that a plan of care is in place. We also reflected on Palliative Care Outcome Scale (IPOS) scores quarterly which showed that often patients continued to score highly for the psychological impact of their illness. We have employed additional members of staff in our Family Support Team and increased the provision of psychological and spiritual support for patients and their families.


We continue to review the type of data we collect and benchmark our progress against our key priorities. Sharing these outcomes with clinical managers and staff helps everyone to understand the importance of accurate and meaningful data.

3. STATEMENT OF ASSURANCE / EFFECTIVENESS

3.1 Services

During 2017-2018, Isabel Hospice provided the following services:

• In-Patient Unit

• Community Clinical Nurse Specialist

• Specialist Medical Intervention

• Hospice at Home

• Day Services – Living Well with Isabel

• Therapies

• Patient and Family Support including children’s services and bereavement

3.2 Income Generation

All our care is free, although our running costs each year are currently £4.5 million, of which £2.8 million must be raised from charitable sources.

3.3 Clinical Audits

As well as monitoring for national standards, audits are carried out to ensure best practice is adhered to; in response to individual initiatives and/or areas of perceived problem and as re-audits to complete the audit cycle and demonstrate effective actions following earlier pieces of work. Isabel Hospice delivers a comprehensive audit programme each year.

Audits requiring actions or learning (80-90% or >80%):

Audit Actions/ Learning

Management of Pressure Ulcers

1. ‘Pressure Ulcer Prevention’ leaflet to be included with discharge paperwork.

2. Changes to SystmOne to allow for more effective recording

3. Ongoing education sessions

Nutrition and Hydration

1. Introduction of the PLANC tool - Patient Led Assessment of Nutritional Care.

2. Current review of templates SystmOne

Record Keeping 1. Change to audit tool as deemed unfit for purpose

2. Introduction of Royal Marsden Manual online

3. Exemplars of care plans for staff

Individualised End of Life Care Plan

1. Teaching/training sessions on completing EOL pathways

2. EOL review for all patients who have died in IPU at weekly IPU MDT.

3. Implementation of the CSNAT tool in April 2018

Information Governance

1. A shortcut icon has been setup on the home screen to Hospice policies.

2. To implement central lockable point for paper patient information to encourage staff not to have confidential information in the drawers, pigeon holes or on their desks.

3. Introduce lockable bag in the community.

Hospice at Home Referrals

1. Hospice at Home referrals guidance to be included within wider referral policy


Audit Actions/ Learning

Community referral and initial assessment

1. Re-write of current referrals policy to include use of patient recorded outcomes in initial assessment and care planning

Consent 1. Duplication of consent information - change to SystmOne core assessment

2. To be discussed in the IPU weekly staff nurse meeting and to include the screenshot of the consent tab from in teaching

Antimicrobial Prescribing

1. Introduction of new drug chart to ensure recording of stop/review date

2. Introduction of ‘to dip or not to dip’ campaign to reduce number of unjustified prescriptions

3. Weekly drug meetings to review benefit of antimicrobials for the purposes surviving infection

Discharge of patients onto CNS telephone caseload

1. Monitoring that IPOS/POI/IPOS has been completed following every first visit/assessment

2. Monitoring that if patients are unable to complete an IPOS a staff or carer version is to be completed

3. All unstable/deteriorating patients to be discussed at weekly community MDT as well as patients who have had a change of phase of illness

4. Monitoring that care plans have been completed for every symptom/problem scoring over on IPOS

5. Guidelines for managing community caseloads using the OACC framework to be distributed to all CNSs

Safeguarding 1. Safeguarding crib sheet published to all staff

2. Regular case studies and checks of understanding at team meetings

The following audits achieved full compliance against the required standards:

• Controlled Drugs Accountable

• Officer Management of General Medicines “NICE Controlled drugs: safe use and management (NG46

• Follow up of Advice Line Calls

• Management of Controlled Drugs

• Bereavement Support Service

Infection Control

As part of the annual Infection Prevention Control programme, Isabel Hospice has:

• Completed a review of departmental report templates. Infection control link workers from each clinical area are required to complete and present a bi-monthly report. These reports have been reviewed to ensure that they include infection control information which is relevant to our patient population.

• Completed a review of audit tools to ensure that they are fit for purpose and to agree the regularity of audits for each clinical area. This has led to the introduction of new audit tools for hand hygiene, catheter care and decontamination of equipment.

• Ensured the safe return to our IPU facility from our temporary residence at Hatfield Nursing Home via robust risk assessments and action planning.

• Developed links with the wider IPC community. The Head of Infection Prevention Herts Valleys Clinical Commissioning Group has attended our infection control meetings and been a source of advice and


support.

• Ensured responsiveness to CCG wide initiatives. We will be rolling out training on the CCG dip or not dip campaign to all our clinical staff during 2017/2018.

• We have also completed a gap analysis against a Hospice infection prevention and control compliance assurance framework. Some of the actions completed as a result of this analysis include:

• Including link practitioner training within the annual programme

• Documented process for the disposal of Isabel Hospice sharps used in the community

• Implementing weekly 15 steps inspection to check clinical equipment

Clinical Governance

Isabel Hospice has a robust accident and incident reporting process and this year has seen a decrease in the number of incidents reported to 332 from 408 last year. All Senior Clinical Team Leaders together with the Director of Clinical Services and Governance Lead review all incidents weekly and establish any further action or learning outcomes.

Learning outcomes were issued and discussed in team meeting for the following incident trends:

Information Governance

• Reminder to staff about their duties to protect personal information by not leaving messages on answerphones, ensuring paperwork is sent to the right printer and documents are shredded when no longer required.

100

90

80

70

60

50

40

30

20

10

0

Accident and Indicent Breakdown

Adm

inss

ion

/ Disch

arge

/ T

rans

fer

Equi

pmen

t

Faci

litie

s

Info

rmat

ion

Gov

erna

nce

Med

icat

ion

- IH

Com

mun

ity -

Med

icat

ion

Pres

sure

Sor

e /

Wou

nd D

evel

oped

in IP

U

Pres

sure

Sor

e on

Adm

ission

Safe

guar

ding

Adu

lt

Slip

, Trip

, Fal

l (Pa

tient

)

Staf

f Inj

ury

Mov

ing

and

Han

dlin

g

Oth

er

Safe

guar

ding

Chi

ld

Incident Breakdown 2016/2017 Incident Breakdown 2017/2018


Medication

• Ensure staff adhere to the medicines management policy and the Nursing and Midwifery code.

Pressure Sore

• Staff to ensure that pressure ulcers are managed in line with best practice.

Safeguarding

• Safeguarding scenarios issued to staff to consider when and how they report safeguarding concerns.

Isabel Hospice has completed the Information Governance toolkit and is fully compliant at level 2.

3.4 Care Quality Commission

We are registered with the CQC and our current rating is ‘Good’. The last unannounced inspection took place 25 and 26 January 2016 and included the following comment:

‘Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support’

4. REVIEW OF QUALITY

4.1 Clinical Complaints

During 2017/18, Isabel Hospice received 16 complaints, which is an increase from 9 during the year 2016/17. As at the date of this report, no complaints have been escalated externally. Therefore, we view this increase as a positive learning experience which has demonstrated that our complaints system is both accessible and responsive.

Out of the 16 complaints, 13 were made verbally and 3 in writing with 80% being made by family members on behalf of the patient.

6

5

4

3

2

1

0

Complaints by subject 2017/2018 (n=16)

Serv

ice

prov

isio

n in

IPU

Disch

arge

pro

cess

from

IPU

Serv

ice

prov

isio

n in

com

mun

ity

Clin

ical

trea

tmen

tSt

aff a

ttitu

de /

beh

avio

ur

Adm

inistrat

ive

erro

r

Nu

mb

er

of

co

mp

lain

ts


Outcomes and learning from complaints

• Service Provision in IPU including temporary relocation to care home

Whilst in Hatfield Nursing Home we endeavoured to continue to provide our usual high standard of care in unfamiliar surroundings with restricted space. Unfortunately, the increased number of complaints during this time indicates that we did not achieve this as well as we would have hoped. In some cases, these were issues out of our control such as the catering, the lack of activity for patients and a temporary call bell system. However, we were able to resolve three of these complaints by meeting with the patient’s family and resolving the issues immediately.

• Discharge process from IPU

Following our move back to our resident IPU at Howlands, the experience of patients and their families was that they felt under pressure to find a nursing home place and there was insufficient follow up from our team once back out into the community.

We want to be responsive to patients and their families, so that we can improve the effectiveness of our services and the experience of our service users. So we have put the following measures in place:

1. Patients will be followed up by the Clinical Nurse Specialist the next day for patients discharged home and within a few days for patients discharged to nursing homes

2. We will now have named staff communicating with patients and their families around discharge to prevent multiple staff asking the same questions.

3. We will be clear with the patient and family who the people are who will follow up their search for a nursing home.

4. All staff will be undertaking mandatory training for communication around discharge to a nursing home.

5. We are developing a patient information leaflet about the option of discharge to a nursing home which will acknowledge the difficulty of that decision

6. We are also revising our list of nursing homes which will be divided into locality and identify which Clinical Nurse Specialist will be visiting. There will also be a separate list of ‘out of area’ care homes.

We will also be inviting some families who have been through the process, to talk through the draft leaflets and obtain their feedback.

All complaints are discussed as learning outcomes at team meetings, irrespective of whether the complaint relates to that team and where appropriate, individuals reflect on their practice.

4.2 Patient experience

Understanding patient experience is an integral part of ensuring that we deliver patient-centred care.

The Friends and Family Test (FFT) is an important feedback tool that supports the fundamental principle that people who use health services should have the opportunity to provide feedback on their experience. Since it was initially launched in April 2013, the FFT has been rolled out in phases to most NHS-funded services in England, giving all patients the opportunity to leave feedback on their care and treatment. It asks the question:

How likely are you to recommend Isabel Hospice to family and friends if they needed similar care, support or treatment? The table below shows the responses:


No responses were received during May. We are looking to improve the uptake of the Friends and Family Test in 2018.2019 by ensuring easier access via our website and Living Well Services.

Some of the comments we have received from service users:

• All of the staff/nurse/doctors were fantastic and very kind and understanding could not wish for better care.

• Mum telling me she was comfortable - I couldn’t have wanted anything more

• Isabel Hospice was a lovely experience and exceeded all expectations. The doctors, nurse’s chefs and staff were absolutely fantastic and so comforting and attentive.

• This was my first experience within a hospice and I was impressed by the positive caring and loving we experienced from every member of staff. Thank you.

• The staff have been wonderful and very supportive and understanding of my husband’s needs.

Views on Care

Following the introduction of our enhanced Hospice at Home team, we wanted to capture patient feedback.

We had an excellent response with 67 returned surveys which asked the following question:

‘How would you rate your overall quality of life before the enhanced Hospice at home team became involved’ and ‘How would you rate your loved one’s overall quality of life following the enhanced Hospice at Home team’s involvement?’

The chart below shows the overall quality of life rating before and following the ‘Enhanced Hospice at Home team’ involvement:

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0

Friends and family test question (n=50)

Perc

en

tag

e o

f re

spo

nd

en

ts

APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR

Extremely Likely LikelyNeither likely or nor unlikely

UnlikelyExtremely unlikely


Patient Experience of Care Questionnaire

We are currently taking part in a national survey. The Patient Experience of Care Questionnaire Project which is being co-ordinated by the Nuffield Department of Medicine Oxford University. The aim of the survey is to provide information on the use of a standard questionnaire in relation to our service.

We prepared and printed a covering letter explaining the reason for the survey, a prepaid envelope and the questionnaire which was provided to us. We were not permitted to make any changes to the questionnaire but we could add questions with agreement from the Nuffield team.

We piloted the questionnaire in our Community service and are now using the questionnaire for our Day Service patients.

4.3 Schwartz rounds.

We are now in our fourth year of running Schwartz Rounds for Isabel Hospice staff. We continue to get very positive feedback with support from the Executive management team and the rounds now form part of our ‘looking after’ staff ethic.

The Round begins with short stories from a panel of three or four people around a prearranged theme. There is then time for discussion and reflection within those attending.

Over the past 5 rounds we have had a total of 76 attendees, averaging 19 per round.

23% of those that attended did so for the first time during this period.

35

30

25

20

15

10

5

0

Overall quality of life rating before and following ‘Hospice at Home team’ involvement (n=67)

1 2 3 4 5 6 7

Pre Hospice at Home involvement

Post Hospice at Home involvement

Linear (post Hospice at Home involvement)

Overall rating of quality of life 1 (ver ypoor) to 7 (excellent)

Nu

mn

er

of

resp

on

den

ts


The titles of the 5 rounds were:

• Breakthrough moments

• You’re on your own

• The ‘D’ word

• Welcome home

• Brain Challenges

The rounds were rated:

Exceptional 19%

Excellent 71%

Good 7%

Annual Conference

Two members of the Steering group represented Isabel Hospice at the Point of care Conference in January. We submitted a poster in the poster competition section and although not a winner, it was short listed and displayed.

4.4 Children’s Drama Youth Play

A new project was introduced by our Children’ Services which allowed children receiving support take part in play which was then performed for their family and friends. The play focused on the feelings around bereavement. The children noted the favourite part of being in Youth Plays:

• The artistic part

• Working with others in a similar situation

• Meeting other people

• Meeting new people

• Making friends

• It is exciting

Feedback

East and North Herts Clinical Commissioning Group’s Response to the Quality Account provided by Isabel Hospice, Hertfordshire

East and North Herts CCG (ENHCCG) has reviewed the information provided by Isabel Hospice and we believe this is a true reflection of performance during 2017/18, based on the information submitted during the year as part of the on-going quality monitoring process.

The Quality Priorities set out for 2018/19 build upon the success from the previous year and demonstrate a commitment to continued quality improvement developing services further whilst maintaining a focus on staff and patient experience.

During 2017-18 the Hospice worked to increase the care offered to patients with non-cancer diagnoses. The Hospice has developed a range of creative initiatives to offer care and support to an increasing number of patients living with long term co-morbidities and has demonstrated how they link up with

For more information [email protected] 382500

www.isabelhospice.org.ukRegistered Charity No. 1046826

Isabel Hospice Schwartz Rounds give opportunity to share the impact of

common experiences

We provide end-of-life care to local people and

their families who are facing a life-shortening diagnosis. Each year we care for around 1,400

patients and 700 family members in eastern

Hertfordshire

“This is a very good network of

support as our job is very

difficult at times”

“Very interesting to hear other

colleagues stories some of which I

could really relate to”

We have found that Schwartz Rounds enable staff to feel more supported in their jobs,

allowing them the time and space to reflect. Evidence shows that staff who attend Rounds feel less stressed and isolated, with increased insight and appreciation for each other’s roles.

Rounds also help to focus attention on relational aspects of care.

At Isabel Hospice the underlying premise for Rounds is that the compassion shown by staff can make all the difference to a patient’s experience of care, but that in order to provide compassionate care staff

must, in turn, feel supported in their work.

Powerfulstories

Sharing ideas

Connectivity with peers

Support from colleagues

Diversity of issues

Reflection of

staff and patient

experiences

Compassionate Care

Emotional support


other services to provide a joined up approach. The hospices’ work to encourage referral of patients earlier is noted, recognising that by doing so patients will have access to care and support earlier which enables them to live as well as possible for longer.

The Isabel Hospice Quality Accounts also highlight an on-going commitment to sharing expertise and knowledge with clinicians, volunteers and organisations by providing a range of learning opportunities in both face to face sessions and eLearning formats. The hospice’s approach to supporting carers is recognised as being important and it is good to see the range of support provided and the on-going collaboration with Carers in Herts.

The Hospice has reported an increase in incident reporting, and we welcome the actions taken to ensure that all opportunities are taken to learn from these and making changes to practice.

During 2018/19 the CCG looks forward to strengthening the positive relationship already developed with the hospice for continued quality improvement for the population of Hertfordshire and for the Hospices contribution to the on-going development of system wide approaches to End of Life care.

Sheilagh Reavey Director of Nursing & Quality East and North Hertfordshire CCG

Healthwatch Hertfordshire’s response to Isabel Hospice Quality Account 2018

Healthwatch Hertfordshire is pleased to submit a response to Isabel Hospice’s Quality Account. The Account is particularly interesting in reflecting the 4 new strategic themes set after Isabel Hospice’s review of the environment in which they work.

The themes (More people; reach people earlier; Educate to share and leverage expertise: Collaboration and partnerships) are then developed in the priorities section with projects and actions to take each theme forward. Within the priorities are important initiatives and projects such as strengthening of relations with GPs and palliative care teams in acute hospitals, enhancing the hospice at home night services and support for carers. We welcome the initiatives with schools and the adding of LGBT information to enhance staff awareness.

The enhanced focus on cross organisational and community engagement is also welcome and HwH looks forward to any opportunities to work together. Like last year, progress to address the previous year’s priorities is shown clearly and is well presented. The shift to increasing the number of non-cancer referrals is significant and the expansion of the day service facilities at Hall Grove shows real progress. The Hospice’s implementation of SystmOne showed immediate benefits.

As a patient voice organisation, we always look for very positive comments made by patients and their families about the care received and there are some powerful messages in the Quality Account. The story of Natasha’s experience demonstrates the importance of the support that Isabel Hospice’s services provide.

Michael Downing, Chair (outgoing) Healthwatch Hertfordshire, June 2018

Documents

QUALITY ACCOUNT - assets.nhs.uk · Natasha didn’t feel ready for Hospice care. “I come from South Africa and there a Hospice is a building where you go and don’t come home again