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Quality Report 2017-18

384 Woodborough Road Nottingham

NG3 4JF

Nottinghamshire Hospice is a registered Charity No 509759

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VISION

Everyone in Nottinghamshire should have a good death. For them and their loved-ones, our end-of-life care and support will be a beacon of hope and excellence in fulfilling this right.

MISSION

To provide Hospice Care in all our communities, led and informed by their needs, striving to add life to every day by:

• Providing therapy based support to enable people to live well and understand the changes they will experience in their lives, their families, carers and communities

• Hospice at Home available in every community • Promoting independence and recovery through appropriate bereavement care • Working with partners and our communities to increase understanding of palliative

and end of life care

VALUES

Care

Providing the right care, at the right time, in the right place by the right person

Acceptance

Accepted in all our diverse communities by growing trust and understanding

Resilience

Building resilience in our patients, carers, families, staff and volunteers to cope and thrive

Empathy

Understanding that loss, grief and bereavement is unique to you and respecting your needs

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Contents INTRODUCTION: ABOUT THIS REPORT Page 4 PART 1: STATEMENT ON QUALITY BY CEO Page 4 PART 2: PRIORITIES FOR IMPROVEMENT Update on Priorities for Quality Improvement 2017 /18

• Review of Day Therapy Unit Page 5 • Review of Clinical Audit Program Page 5 • Induction and training programme for volunteers in the Page 6

bereavement service • Building Better Hospice Governance Page 6 • Review patient survey Page 6

Priorities for Quality Improvements 2018/19

• To embed the OACC assessment tools within the Day Therapy Service Page 6 • To review the Hospice at Home offer Page 7 • To widen access to hospice services Page 7 • To embed Nottinghamshire Hospice in Mid Notts as a partner in Page 7

the Better Together - End of Life Care • Developing a strong leadership team both within our Care Page 7

Services management structure and Corporate Management team

PART 3: STATEMENTS OF ASSURANCE / REVIEW OF QUALITY PERFORMANCE Board of Trustees Page 7 Quality and Innovation payment framework Page 8 User Engagement Page 8 Duty of Candour Page 8 Safety of Controlled drugs Page 9 Infection Control Page 9 Education and Training Page 10 Nurse Revalidation Page 10 How we Safeguard People Page 10 What others say about our Services

• Patients Page 11 • Students Page 12 • Commissioning Groups Page 12

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Quality accounts were introduced in 2009 to make healthcare organisations more accountable when it comes to quality of care. Each organisation is required to report on their performance against the targets they set for themselves last year, 2017/18 and to share their targets for next year, 2018/19. Every NHS organisation is required to include some specific standard information and data which they provide to national bodies. Much of this information is not applicable to Nottinghamshire Hospice as we do not submit information into national bodies and will therefore not be included in this report. Throughout the document we have used the term patients, families and carers to mean any person who has used or will use our services. Layout of the report

Part 1: Statement of quality from the Chief Executive officer

Part 2: Sets out our performance against priorities for Quality Improvements in 2017/18; Priorities for Quality Improvements in 2018/19; Statement of Assurances from the Board; National Quality Indicators priorities and objectives for 2016/17

Part 3: Review of quality performance 2016/17; describes how we have done

I am pleased to recommend to you our Quality Account 2017 1-2018. During the year we have focussed on improving patient experience through better understanding their needs and supporting their choices in how and when they use Nottinghamshire Hospice services. During the coming year the Hospice will build on this work through the introduction and embedding of the OACC assessment tools. The scheme is widely used to measure steps towards patient goals, wellbeing and the wider environment that the patient experiences. This understanding will underpin the review of Hospice at Home, ensuring the service is both sustainable and flexible to support patients and their families.

In 2017-18 the Hospice has invested it’s time in the development of a new integrated pathway for end of life in Mid Nottinghamshire. The model breaks down traditional barriers between providers and introduces a single point of access with clinical triage. This will align the service to the way of working Nottinghamshire Hospice currently uses in the City of Nottingham and South Nottinghamshire, we anticipate similar improvements in communication and more patients achieving their preferred place of care and death.

INTRODUCTION About this report

PART ONE Statement on Quality by CEO

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In June 2017, Joanne Polkey was appointed as Director of Care, she had previously worked for the Hospice in the role of Care Services Manager so brings her practice, knowledge and skills to the role. Supporting Jo is Elizabeth Morgan who joined the Hospice from CityCare. Liz brings with her in depth knowledge and expertise in patient care in the community as well as her practice within Cancer Care. Together they are well equipped to deliver our priorities for quality improvement during 2018-19.

Rowena Naylor- Morrell Chief Executive Officer Nottinghamshire Hospice

PART TWO Priorities for Improvement

Update on Priorities for Quality Improvement 2017 /18

In 2017 Nottinghamshire Hospice identified a number of areas for improvement these were identified through clinical governance processes and as a result of changes in the end of life contract locally.

1. Review of the Day Therapy Unit.

The Day Therapy staffing model and model of care has been reviewed and is in the process of transition. The focus has been moved towards Rehabilitative Palliative Care and a more bespoke flexible model to meet individual needs. The Hospice now employ a Clinical Nurse Specialist who is also a Nurse Prescriber giving a more holistic approach to looking after the needs of patients attending the unit. The employment of an Occupational Therapist has significantly helped move the focus of care towards palliative individual goal setting. The introduction of Outcome Assessment and Complexity Collaborative (OACC) has provided us with the tools to start to measure the patient benefits clinically. These changes are in the early stages and this will continue to be a focus as we go into 2018/19.

2. Review of clinical audit programme.

The audit programme was reviewed by the Quality & Safety group and has been modified. This was submitted and agreed by the CCG who monitor our Quality. In addition to the mandatory audits the Group agreed additional audits would come from incidents in order to understand root cause and embed learning across the teams.

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3. Induction and training programme for volunteers in the bereavement service.

The Carer and Bereavement service had investment from the Hospice and an additional post was commissioned. Therefore 2 part-time posts now cover the two different elements of the service, Bereavement and Pre-Bereavement and Carers. The service launched its Bereavement Support Volunteer induction at the beginning of 2018 to prepare volunteers to undertake this complex role. The training was successful and the support volunteer service is now supported by ten volunteers. This induction will be reviewed and rolled out to new volunteers within this service.

4. Building Better Hospice Governance.

The Board of Trustees have signed up to review their practices following the attendance of the Deputy Chair at the Building Better Hospice Governance National Conference in February 2017. This will take into the account the revised Charity Governance Code (2017).

5. Review patient survey.

The Hospice has used a variety of methods to undertake patient and carer feedback. Focus groups have formed the basis of Day Therapy feedback and this has been facilitated by a Support Service Volunteer. Feedback has been given to the patients in the form of ‘You Said We Did’ to show how we are listening to their views. We are in the process of working with the Greater Nottingham Cancer Forum, who are a dedicated established group of Volunteers whose purpose is to improve the lives of those people either living with or supporting someone with cancer. They have broadened their remit to work with us to look at all conditions in the knowledge that improving the care experience is their priority. They have carried out a service feedback questionnaire with carers and those who were caring and are now bereaved. This report is being finalised and will be used to inform our care going forward.

Priorities for Quality Improvements 2018/19

The Hospice has agreed for the next year to set no more than five improvement priorities to ensure that it retains sufficient capacity to continue to embed the changes from this year. The Hospice is also keen to ensure that any improvements are completed to a standard that ensure the ongoing quality and safety to our service users, staff and volunteers.

This year we have set the following priorities for Quality Improvement;

1. To embed the OACC assessment tools within the Day Therapy Service to enable the service to demonstrate the patient Outcomes in a more universally understood

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way. This will also support the quality areas of our service and those that require additional development.

2. To review the Hospice at Home offer and consider the sustainability of the service through developing to meet the needs of patients and their carers to support them to remain in their preferred place of care.

3. To widen access to hospice services for patients and their carers by considering

different referral models, for example working with Urgent Care Services in our acute hospitals.

4. To embed Nottinghamshire Hospice in Mid Notts as a partner in the Better

Together - End of Life Care work taking place in remodelling the offer in Mid Notts. Creating a streamline and robust End of Life service for patients and their carers where they can be supported to live within the community, reducing hospital admissions and increasing care in their preferred place.

5. Developing a strong leadership team both within our Care Services management

structure and Corporate Management team. Leadership and management skills are key to a strong team and there are new managers and new members of the team who need to come together in their understanding of the hospice vision and values and develop the skills to lead as a team.

PART THREE Statements of Assurance / Review of Quality Performance

Board of Trustees

The Board of Trustees contribute to the development of Nottinghamshire Hospice strategy and play an important role in scrutinising management in achieving agreed goals and objectives and monitoring the reporting of performance. Trustees are drawn from the local community and can ensure that the voice of the public is heard in decision-making processes and that the interests of patients remain at the heart of Board discussions. The Board also has a blend of knowledge and skills to ensure that the board holds expertise and experience in the different sectors of the organisation. This year the board has appointed a new Chairman after the previous Chairman stood down after three years as Chair. The Board also has a role in working with the Chairman in the appointment and remuneration of the Chief Executive and other Directors. All of our Trustees, including the Chairman, are considered to be independent.

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Quality and Innovation payment framework

A proportion of Nottinghamshire Hospice income in 2017/18 was conditional upon achieving quality improvement and innovation goals agreed between Nottinghamshire Hospice and any organisation they entered into a contract, agreement or arrangement with for the provision of relevant health services, through the commissioning for Quality and Innovation payment framework. CQUINs are intended to reward excellence and encourage providers to drive a range of quality improvements on a continuous basis. Commissioners and providers agree each year the detail of how national and local priorities will be measured and achieved. A series of milestones and targets are agreed in advance and each provider is required to submit evidence to commissioners at regular intervals. Nottinghamshire Hospice has met the requirement under CQUINs and received payment. This has now been replaced with a local incentive scheme and QUIPP, both of which Nottinghamshire Hospice are achieving. Care Quality Commission

During the period covered by this report Nottinghamshire Hospice’s services were registered by the Care Quality Commission. On 1 April 2015 a new system to inspect providers underpinned by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 came into effect.

The Care Quality Commission inspected the Hospice on November 29th 2016 using this new system. The hospice received a good in a categories and an overall rating of good. There were there no improvement or recommendations issued. The full inspection reports for the hospice and the clinic are available via the Care Quality Commissions’ website by following this link http://www.cqc.org.uk/location/1-109940901 The Hospice is expecting to be inspected under Independent Healthcare Services when it is next due.

User Engagement

The hospice promotes active engagement by patient users through focus groups, facilitated by a Support Services volunteer. In addition to this the Hospice has worked with the Greater Nottingham Cancer Forum to facilitate carer feedback. Patients also use volunteers as their voice.

The hospice has feedback forms readily available for all patients and visitors to make comments on, and suggestions for, the services we offer.

Duty of Candour

A culture of Candour is a prerequisite to improving the safety of patients, staff and visitors as well as the quality of Healthcare Systems. This means that patients should be well informed about all elements of their care and treatment and all staff have a responsibility to be open and honest, especially when errors happen. The Hospice has reviewed its practices and actively promoted openness about its practices and all staff especially managers make sure that if mistakes are made, the affected person:

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• Will be given an opportunity to discuss what went wrong. • Will receive feedback on findings from any investigation. • What can be done to deal with any harm caused? • What will be done to prevent it happening again? • Will receive an apology.

All incidents and complaints are recorded reported to the trustee led Quality and Safety Group.

Safety of Controlled drugs

Following the Shipman Inquiry there is a requirement for the Health providers to appoint an Accountable Officer for Controlled Drugs (CDAO). The CQC also maintains a register of CDAO in registered services. The role of this person is to ensure the safe management of controlled drugs from ordering through to their disposal. The appointed person for this role at Nottinghamshire Hospice is the Director of Care Services. Within these responsibilities is a requirement to make quarterly reports to the Local Accountable Officer for Controlled Drugs appointed by NHS England on any concerns within the organisation.

The Hospice does not have an inpatient unit and therefore does not hold any stocks of controlled drugs. The Hospice does however have in place facilities and processes to manage controlled drugs for patients when they attend the Day Therapy unit and when staff are administering controlled drugs in a patient’s own home.

During the period of this report The Accountable Officer has not identified any concerns. The Accountable Officer receives the minutes of and is invited to attend the Local Intelligence Network (LIN) meetings where areas of good practice or concern are discussed.

Infection Control

Nottinghamshire Hospice is committed to the prevention and control of infections and has policies and procedures in place. These policies and processes have been reviewed in 2017. Training is also provided by our nurses and external trainers to all staff and volunteers. Training varies depending on role and individual development needs.

Our Infection Control link nurse has left and we have recruited a nurse who will take up the responsibilities and attend an accredited course to ensure that her skills reflect the latest research and evidence so the hospice complies with the requirements of the Health and Social Care Act 2008.

The hospice is a community hospice and as such does not have any inpatient beds; to date the hospice has not had incidents of cross infection. Patients attending who take unwell or are suspected of having a significant infection can be isolated and returned home without putting other patients at risk.

A full infection control audit is carried out twice a year. This is based on the Health and Social Care Act 2008 ‘Code of Practice’ which set out the ten criteria against which a registered

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provider will be judged on how it complies with the registration requirement for cleanliness and infection control. The outcomes of this are reviewed at the Hospices Quality and Safety Group which meet two monthly.

Education and Training

Senior Managers supported by the Board of Trustees are committed to the professional and personal development of staff and volunteers, especially those that are involved in the delivery of care.

The Hospice has a rolling programme of mandatory training which includes cardiopulmonary resuscitation, tissue viability, manual handling, equality and diversity, safeguarding, mental capacity and deprivation of liberties. In additional the hospice offers reasonable support to undertake accredited courses for staff to improve their knowledge and expertise in palliative and end of life care.

The training programme is reviewed annually to ensure it provides staff and volunteers with the knowledge and skills to be able to provide safe high quality care. Attendance at training across the care team is 75% (this includes new starters and staff on sick leave). The hospice has policies and procedures to performance manage staff and volunteers who do not attend mandatory training.

Nurse Revalidation

From 1st April 2016 a new revalidation process has been introduced by the Nursing and Midwifery Council for registered/ qualified nurses to provide assurance of the quality of nurses. Failure to revalidate will result in the registered nurse not being able to practice. The Hospice has put in place the processes for preparing and supporting staff to ensure they are were aware of the new requirements and have the resources and information they need to be able to complete their revalidation in a timely manner. The Hospice already had in place a system so that it is aware of when nurses pin numbers are due to expire in order to ensure that all nurses working are legally registered to work as a registered nurse in the UK. How we Safeguard People

The Hospice is committed to the well-being of all people using our services and takes the safety of vulnerable adults and children very seriously. We work in partnership with local authorities to safeguard vulnerable adults and children. Over the year we have make four safeguarding referrals to the Local Authority. These were all submitted on behalf of patients and not about the care provided by the hospice. The Hospice supported the patients through any subsequent investigation and responded to the LA as required. Each local authority has its own safeguarding adult board and safeguarding children’s board made up of nominated lead officers from key organisations within each local authority. The

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“Its logo is ‘adding life to days’ and I think that’s perfect.”

It makes you realize how safe you are here at the hospice.”

Thank you for the support and compassion shown to my grandad during his short illness. Your service is one in a million.

Thank you

Hospice is not required to attend board meetings but do respond to any request for information or support. The safeguarding lead for the Hospice is the Director of Care Services. The hospice has fully introduced PREVENT training during 2017 to all care staff.

What others say about our services?

Patients

When completing this report we asked our patients what they would like to say about the care they get through the focus groups and they said:

I don’t know what I would do if I didn’t come here. It’s

brilliant

…made a heart-breaking experience slightly easier for us by your

presence and amazing devotion, it was truly humbling to see such care

first hand.

We both benefitted from your kindness and willingness to stand with us as we passed through a really hard time. Your presence bought light and life into my husband’s darkest hours.

“I thought it was going to be horrible.” This patient hid behind a book for 3 weeks. Then they thought it was “wonderful – I wouldn’t be here now if I hadn’t come here.”

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Students

The Day Therapy Unit now has 4 Student Nurse Mentors and has benefitted from the experience they bring, with one being a sign off mentor. The Hospice has a range of students in addition to the Student Nurses from Pharmacy, Medicine and Social Work placements.

The Hospice was also audited by Nottingham University for placement of Student Nurses with no outstanding actions.

Below is a quote from a student nurse evaluation for placement 01.01.2018 to 31.03.2018.

I enjoyed my placement, learned new skills, fantastic mentor who was caring understanding, sincere, very supportive and helpful. Thanks to the whole team, who made me feel part of the team straight away, I felt included and met some lovely staff and patients.

Commissioning Groups

‘’South Nottinghamshire Clinical Commissioning Groups (CCGs): Statement from Nichola Bramhall, Chief Nurse/ Director of Quality, Greater Nottingham Clinical Commissioning Partnership on behalf of NHS Nottingham North & East, NHS Nottingham West and NHS Rushcliffe CCGs.

In April 2016 The Nottinghamshire Hospice was awarded the contract for end of life services by the South Nottinghamshire CCGs. Throughout 2017/18 the Nottinghamshire Hospice team have continued to work collaboratively with the CCGs’ contract and quality teams to provide assurance of the quality and effectiveness of the services they deliver to patients and carers.

The hospice has demonstrated achievement across all areas of the agreed quality schedule, ensuring high quality services for the people of South Nottinghamshire. In addition the hospice has developed and shared a quarterly quality report highlighting quality indicators such as patient feedback, staff engagement and learning from patient safety incidents. The South Nottinghamshire CCGs agree that this Quality Account is an accurate record of the provider’s achievements and challenges and fully endorse the priorities for quality improvement in 2018/19. We look forward to continued collaborative working with the provider to further develop the quality schedule and quality reports with a view to maintaining high quality care and experiences for those patients and their loved ones needing Palliative and End of Life Care and support.‘’

“CityCare: statement from Aimee Baugh, Business Development and Contracts Manager on behalf of Nottingham CityCare Partnership

Following three years of successful partnership working to deliver coordinated end of life care for Nottingham City patients in August 2017 CityCare and Nottinghamshire Hospice

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were keen to work together once again to submit a partnership bidder to deliver end of life care as part of the Nottingham City Out of Hospital Community service contract. The bid was successful, securing the partners a potential 9 year contract to build on the achievements of the last three years to ensure the highest standard of care at the end of life. CityCare is proud of its partnership with the Nottinghamshire Hospice and credits this joint working approach to helping its end of life service achieve a rating of outstanding by the CQC during our 2017 inspection, but allowing clinicians from across services to come together to provide truly joined up care for patients and their families. As a direct result of this integrated approach to care delivery we are proud to be able to claim that 100% of patients with active involvement from our end of life care services achieved death in their preferred place of care and are committed to embedding this further over the next 9 years. “

Joanne Polkey Director of Care July 2018