quality account 2018-19 · 2019. 8. 27. · the mary ann evans hospice (mary ann) underwent an...

Quality Account

2018-19

Providing exceptional care for people

approaching the end of life

of 39 Quality Account 2018-19

Our CQC Rating


Table of contents

Part 1 – A statement on quality

Page

The impact of hospice services on our local community 4-6

Our Chair’s statement about quality 7

Registered Manager’s statement 8

Background and summary information 9-10

Part 2 – Priorities for improvement

Improvement priorities for 2018-19 11-12

Priority 1 11

Priority 2 12

Priority 3 12

Progress with improvement priorities identified for 2017-18 13-14

Statements of assurance from the Board 15-20

Our participation in clinical audits 15-17

What others say about us 17

Data quality 17

Information Governance Toolkit attainment levels 18

Duty of Candour 18-19

Learning From Deaths 20


Part 3 – A review of quality performance

Page

Review of quality performance 20-34

National currency 25

Quality Markers and Patient Safety Indicators 26

What patients say about the Hospice 26-29

What our staff and volunteers say about us 30-34

Who has been involved in this report 34

Annex 35

Statements from our Commissioners, local scrutineers and key partner providers

35-37


The impact of hospice services on our local community

This past twelve months the Hospice has

further built on our partnership working

approaches across all departments – clinical

and non-clinical. Ultimately all of our work

and sustained efforts have contributed to

make a tangible impact for end of life care

locally as demonstrated by this

comprehensive report. I continue to be

extremely proud of all our achievements.

Elizabeth Hancock

Chief Executive

On behalf of the Trustees it is good to

reflect on a successful year where our

services have increased and quality has

been assured. Plans for the future are

well established and illustrate a

leadership commitment as well as a staff

and volunteer enthusiasm for providing

the best possible experience for patients

and clients.

Heather Norgrove

Chair


Referrals and contacts headlines

A total of 1026 referrals were received for our combined clinical services and an

additional 1538 referrals were made to our partnership with South

Warwickshire NHS Foundation Trust (SWFT) Rapid Response overnight service.

485 people accessed care from our Day Hospice and Hospice at Home service.

An average monthly caseload of 416 people received a total of 3152

lymphoedema treatments.

Over 900 complementary therapy contacts were given to our patients.

Just over 1200 adult bereavement sessions were provided for over 160 adults

and over 70 children received 580 contacts from the care of our Family Support

and Bereavement team. Average length of intervention is less than four months,

and in this time individuals will receive average of 9 sessions of bereavement

support, mainly from trained volunteers.

Through the partnership Rapid Response (overnight) service we also provided

1479 home visits for 823 people in north Warwickshire and Rugby (from

October 2018) between the hours of 8pm – 8am. Almost 100% of calls for help

received a visit within 2 hours, and on average just under 90% of these were

within 30 minutes in north Warwickshire.

The Day Hospice and Hospice at Home services provided care to 339 new

patients.

Over 90% of patients receiving Hospice at Home care continue to remain at

home to die.


“The Carers Cafe at the Mary Ann Evans Hospice is a pleasure to attend. Carers alike share their

worries, ideas, laughs and tears. We are all in the same position and need each other. XXX organises

talks, social events and hands on relaxation sessions which help tremendously and makes us chill for a

while. The help and support of XXX and her team of colleagues and volunteers is exemplary. My and

other attendees of the cafe I'm sure will join me in saying a big thank you.”

“I currently have my Grandad living with me, seeing his last few weeks with us. I have Mary Ann Evans

Hospice coming in and looking after him ……absolutely speechless they are absolutely amazing. I can’t

thank these ladies and gentlemen enough for what they do for my Grandad. My heart melts when I see

how genuine they actually are. The support I get as a main carer is second to none. I couldn’t put into

words how grateful I really am so THANK YOU xxxx.”

“Once again the Rapid Response team (at night) has proved an invaluable service to us. We would be in

a sorry state without it. As part of the NHS/Governments 'treatment in the home' directive to stop bed

blocking this service plays an essential part and must be allowed to continue. Thank you for this

fantastic service.”

“Care by XXX was offered with compassion. XXX knows the staff really well. XXX was kind and gentle.

Took my history and offered personalized treatment according to my needs. Very impressed; thank you

so much XXX for being so professional and brilliant.”

“Care is first class and with no preference regards our illness and circumstances, well done.”

“XXX has been amazing. XXX is so professional throughout the process. XXX has shown me different

massage techniques to resolve the problem I was having. Everyone in the centre is so

lovely and seem happy within the work place which is lovely to see. Keep up the good work all, you are

all amazing.”

“Thank you for helping us. You are so kind but when we leave the Warren we still are sad about our

daddy because he is poorly and we miss him and we love him. You are the prettiest person I have ever

seen in the whole wide world.”

“I wish to express my grateful thanks for the support you have given me over the past 9 months. We

met at a particularly awful time in my life and you have helped me to glimpse the light ahead. I feel you

were the ideal person to be matched with me, your quiet approach, your kindness and patience has

been such a help and support. I know the time has come for me to try and look to the future and not be

so focused on past events and I thank you for helping me reach this point. You have helped me put

things in perspective and in particular meeting the doctor was a great help and I thank you for

arranging that. I will never forget you, your quiet skilful guidance has meant a lot to me.”

Patients’ and Carers’ Comments


Our Chair’s statement about quality

The Quality Account for 2019 reflects the exceptional work delivered by our staff and volunteers to the

benefit of the community in northern Warwickshire. Led by our Senior Leadership Team, the quality of

clinical services, support for clients experiencing bereavement and for carers is evident throughout.

Less obvious, but equally important, is the effort of the staff and volunteers who run the shops and

raise income for our charity. Without them none of the clinical outcomes would be possible and the

care offered to families would suffer significantly. So, it is a whole team effort for which the Trustees

are extremely grateful.

Recognition of the locally relevant nature of our services and that as a charity we are substantially

dependent on the generosity of beneficiaries, supporters and other philanthropic contributions remain

a challenge. The grant received from the NHS has been frozen since 2012 and now constitutes 25% of

our income rather than the 35% of 2012. The Trustee Board is concerned that although national

charities in the field can have the benefit of national widespread publicity and can attract larger

donations, these do not feed directly into local services and it is the local nature of the hospice

movement which is its great strength, as illustrated in this Quality Account.

The partnership with South Warwickshire Foundation Trust (SWFT) to deliver a rapid response service

to patients and their carers living at home and facing crises outside normal working hours continues to

pay dividends. Our reliance on the contribution of volunteers is self-evident and the Trustees welcome

the opportunity revitalise our volunteer strategy. Indeed, as a volunteer in our bereavement centre, I

know from personal experience, the value placed on our services by the clients we support. Clinical

quality in the context of an increasing workload is also evident in this account and is a priority which

the Board and I share. Thanks to staff and volunteers for another successful year.

Heather Norgrove

Chair of Trustees


Registered Manager’s Statement

Together with the Board of Trustees, I would like to thank all of our staff and volunteers for their

achievements over the past year. It has been both an exciting and challenging year for us as we have

implemented our new clinical workforce structure and further developed all our services. Mary Ann

has continued to provide care services in partnership, whilst also focussing on sustainability and

meeting local people’s changing needs.

Mary Ann have for the time frame of this report, sustained providing all our existing services to a high

standard and further expanded care provision. Financial resources have continued to be tightly

controlled and we have been extremely grateful for the generous local support as well as numerous

grants from other charitable organisations, the local CCG and Warwickshire County Council. Each year,

Mary Ann’s annual expenditure rises as costs increase, and services develop - including across our

retail sector. The Board of Trustees and Senior Leadership Team are fully committed to ensuring these

increases are balanced with sustainable income generation sources.

The feedback quotes from people, including children, demonstrate how valued and appreciated our

services are. As a small charitable community hospice we highly value all the freely given time from our

dedicated volunteers – who are essential to our whole workforce efficiency.

Mary Ann has well-established business and clinical governance systems and processes. This also

ensures we are able to critique the care provided and for this to remain a very high standard, whilst

also encouraging us to strive for further improvement in the services delivered and the quality of the

care we give. Mary Ann takes its responsibilities under the Duty of Candour very seriously and has

robust mechanisms in place underpinned by our culture of continuous quality monitoring.

We had our last unannounced Care Quality Commission inspection in August 2014, which was reported

in January 2015. Our overall rating was “Good” and we submitted our most recent Provider

Information Return in November 2016, at the request of the Commission. Although we have not been

approached by our regulators Mary Ann has undertaken internal mock inspections with the support of

our Trustees which demonstrates how committed we are to ensuring that our patients and their

families receive care and services which are safe, caring, responsive, effective and well-led. We have

engaged with our services users on an iterative basis and to contribute to this report. I am responsible

for the preparation of this report and its contents. To the best of my knowledge, the information

contained in this Quality Account is accurate and a fair representation of the quality of healthcare

services provided by Mary Ann.

Mrs Kay Greene , Registered Manager


Background and summary information

The Mary Ann Evans Hospice (Mary Ann) underwent an unannounced inspection by Care Quality

Commission (CQC) on 13th August 2014 under Section 60 of the Health and Social Care Act 2008. Mary

Ann achieved an overall rating of good, with grading’s of good for safe, effective, caring, well-led and

responsiveness. No areas of shortfall were identified. Our simulated inspections, undertaken by our

Trustees have been very constructive and helped staff understand what is likely to happen when a

regulated inspection occurs. Mary Ann continues to submit reports as necessary to the CQC which

predominately are related to deaths of patients when a member of staff is present at the actual time

of the death.

Mary Ann has continued to provide quarterly activity reports to the NHS clinical commissioners using

the framework provided. The Director of Clinical Services, who is the Registered Manager for Mary

Ann appreciates the opportunity to discuss the information contained in the Hospice’s quarterly

activity data and quality metric reports at the Clinical Development and Quality Sub-Committee

meetings. Through these discussions and reporting mechanisms, we are able to demonstrate our

commitment to quality assurance and co-operation with others. Furthermore, we are able to

demonstrate where any improvements are required and any system wide learning that may be

beneficial from any reported events. This governance framework also ensures this learning is

translated into practice and ensures any necessary improvements happen whilst also evidencing the

positive outcomes for patients and their families who receive our care.

This past 12 months Mary Ann has developed a new organisation wide strategic plan, which embraced

the local Working Together Board philosophy and considered the constant rapidly changing health and

social care environment.

Local context

The end of life population in the Warwickshire North Clinical Commissioning Group (WN CCG) area is

approximately 1,400. Typically, 44% of deaths locally happen at home, either in a care home facility or

in a private residence. Mary Ann’s Hospice at Home service will have been involved in approximately

30% of these deaths, an increase on last year, however 55% of these 1400 people will likely to have

benefitted from our joint Rapid Response at night service. Deaths in the acute setting continue to be

slightly above national average. The local Out of Hospital Collaborative, of which Mary Ann are a local

stakeholder provider, sets out ambition to deliver care closer to home, and enable individuals to be

seen and supported outside of an acute setting in a timely, responsive, effective way. The Rapid

Response service has been a significant step forwards in achieving this ambition.


Delivering Cost-Effective Services

Mary Ann received approximately 25% of the funding for care services from WN CCG and the

remaining 75% from the local community.

The grant for 2018-19 remained static, which has been the case for the past eight years. Mary Ann

was delighted to have the partnership Rapid Response service formally commissioned and to receive

an additional financial contribution from WN CCG to the existing grant for this service. There have

been additional small grants for specific work e.g. a Motor Neurone Disease Nurse Co-ordinator 7.5hrs

per week, contribution to the Day Time Rapid Response pilot and Professional Advisor for the CASTLE

(EPaCCS) Register (Primary Care) at 22.5 hours per week.

Mary Ann is awaiting confirmation of funding for 2019-20, this will now be under the remit of the local

“Out of Hospital Collaborative”, for which the Lead Provider organisation is SWFT.

From national networking it is apparent most hospices are facing enduring financial pressures and the

necessity to improve income generation whilst continuing to ensure services are developing

innovatively and cost effectively. Our ambition is to continue to improve and develop services in

accordance with local needs, whilst ensuring that this is accomplished within agreed Mary Ann

resources.


Part 2 Priorities for Improvement 2019-2020

We are really pleased to have consulted with our patients, carers and clients as well as in conjunction

with the local North Warwickshire Working Together Board End of Life Care Pathway aspirations (Out

of Hospital Collaborative) to formulate our priorities for the year ahead.

Priority 1

Improve fulfilment of preferred place of care and death in community

setting

Mary Ann will achieve this priority by:

1. Working in partnership with SWFT to provide a 12 month pilot daytime Rapid Response service

for rural north Warwickshire area, including Atherstone and Coleshill area – specifically by:

a) A partnership project comprising of Band 6 Registered Nurses from Mary Ann working

alongside a community staff nurse Band 5 from SWFT to provide rapid response to end of

life patients from 07.30am to 8pm each day of the week. This team will be able to

respond quickly to provide rapid assessment and support for changing needs of those at

the end of life whilst also further enhancing community staff nurse skills, knowledge and

ethos of care of people at the end of life, and ultimately enabling home, including care

home, to be the place of care and death where this is preferred.

2) Be an integral part of multi-agency approach enabling people at end of life to return home from

acute settings, and continue to engage and support new initiatives in local acute trusts to

facilitate home as preferred place of care and death, for example our collaborative Carers

Support Monitoring System project.

3) In conjunction with local partners, review and develop approaches to supporting and enhancing

care in local authority settings

4) Continue to explore and develop Rapid Response (at night) end of life care service

These improvements will be measured by:

5) Data report of activity and achievements in respect of place of death in conjunction with local

known data – ultimately looking for increase in % of people being cared for and dying, in their

usual place of residence.

6) Evaluation summary report of impact of Day Time Rapid Response pilot & night service

developments

7) Interim summary report of impact of Carers Support Monitoring System project


Priority 2

Develop an organisation wide volunteer strategy

Mary Ann values the vital contributions made to core service delivery through our volunteer workforce

and recognises the need to review this with a dedicated strategy to support fulfilment of Mary Ann’s

Development Framework and will do this by:

1) Discussion with, and inclusion of, existing volunteers, staff, and Trustees to consider and

contribute to the strategic review and forward plan

2) Development of a plan with clear vision, ambitions, work plan and measurable outcomes

The impact and progress of this priority will be measured by:

3) An annual review as part of a three year work plan and evaluation – ultimately enabling flexibility

and adaption as necessary to align with local and national volunteer recruitment and retention

challenges.

Priority 3

Contribute strategically and operationally to end of life care education and

training initiatives across Warwickshire footprint.

Having the skills, knowledge and ethos to provide good end of life requires lifelong education and training and has been highlighted in the North Warwickshire Working Together Board End of Life Care Pathway as underpinning the care necessary to ensure good outcomes for people. Mary Ann will contribute to this initiative by: 1) The Director of Clinical Services representing Mary Ann as part of a Warwickshire wide strategic

group developing a flexible, blended comprehensive approach to end of life education and

training

2) The Clinical Practice Lead representing Mary Ann at the CASTLE education sub group of core

providers across Warwickshire, and Coventry.

The success of this priority will be demonstrated by: 1) The development of a comprehensive plan for county wide education and training

2) Provision of the education and training plan operationally and report of what has been delivered.

These priorities also fulfil aspects of Mary Ann’s Development Framework priorities whilst also

being in line with the North Warwickshire Working Together Board End of Life Care Pathway and

fit with the strategic and operational aims of the collective partner providers.


Our progress with improvement priorities identified for 2018-19

Priority 1

Improving responsiveness of community end of life care services in

partnership

Mary Ann achieved the following progress with the above priority in 2018-19 –

Mid-year we successfully appointed a Clinical Services Development Lead, part of this position

was to also function as an Advanced Nurse Practitioner. The post holder has been developing key

working relationships and has advised and supported Mary Ann staff, community and acute

colleagues with rapid assessment and support for changing needs of those at the end of life.

Furthermore, the post holder will be working clinically as part of the daytime rapid response pilot

project service when necessary going forwards.

The learning achieved from the rapid response (at night) project, now a commissioned service,

has led to the extension of the service to cover Rugby area – also inclusive of care home setting.

In north Warwickshire it has taken a while for the service to be known as available for care

homes and as this is a pilot for Rugby area similar is happening.

We have been attending our most local acute trust end of life steering group meetings and as

part of this, a review of the ‘rapid home to die’ processes has been completed.

As a consequence of the success of the rapid response service (at night) we were invited to

develop a model for day time – this pilot project, in conjunction with SWFT will commence in

June/July 2019.

We have successfully introduced real-time service evaluation, an electronic (and paper) patient

and carer satisfaction feedback mechanism – iWantGreatCare, further details available from:

https://www.iwantgreatcare.org.

Priority 2

Progress and embed new clinical workforce structure

Mary Ann revised the clinical workforce structure to begin to fulfil our ambitious clinical strategy and

vision as well as the professional workforce challenges, we achieved this by -

Introduced a shared Advanced Nurse Practitioner position as part of the Clinical Services

Development Lead post

Introduced of a new role of Clinical Practice Educator to support professional development of

existing staff, new staff recruited and embrace new ways of working across Mary Ann clinical

services, included volunteers – now a specific priority for forthcoming year

Introduced Clinical Services Team Lead post with devolved leadership and day to day

coordination responsibilities to Registered Nurses

We have completed the first review of the new workforce model

https://www.iwantgreatcare.org/


Priority 3

Newly bereaved partnership contact points

Mary Ann’s bereavement service had aimed to increase the number of referrals to our bereavement

support service by 30% through the establishment of a drop-in session called Stepping Stones. Below

summarises how this grant funded project evolved during 2018-19 –

We worked alongside three local Funeral Directors and the local Crematorium to provide a drop-

in session for those who were newly bereaved.

A weekly or fortnightly drop in session was provided either at the Warren (the Hospice's bespoke

building primarily used for bereavement) or at Smiths’ Funeral Director for people who were

newly bereaved. Each session was manned by volunteers and staff from the bereavement team

with the idea of people joining small groups to talk as necessary. Refreshments were offered

during the sessions.

We looked at other strands of our bereavement service to ensure their sustainability; this

resulted in reducing the number of Jigsaw sessions per month (a social model of support) to

allow some volunteers to move from that level of support to the Stepping Stones project.

By the final Stepping Stones session, we had seen a further 40 adults and 8 children. Of these, 8

adults decided that they did not need any additional support from our other Bereavement

Services. However, we achieved over 30% increase in referrals for children to our previous year,

and 20% increase to our adult services in this year.

Our relationship with the three Funeral Directors and the Crematorium has deepened however

the project has shown how incredibly busy they are, and how it has been difficult for them to

find the extra time and space for the project apart from advertising the Stepping Stones’ drop-in

dates.

The biggest learning has been in seeing how complex this piece of work has been. We

recognised very early on the term ‘drop-in,’ in no way illustrated the complexity of the

project. We quickly recognised we had to work hard at ensuring other layers of our service offer

stayed sustainable as this project took much more staff’s time than we originally anticipated.

As the year progressed we recognised that Stepping Stones could only be a pilot project and we

concluded the project at the end of February 2019.


Statements of assurance from the Board The following are a series of statements that all providers must include in their Quality Account which

demonstrate Mary Ann’s drive for quality improvement. Many of these statements are not directly

applicable to hospices.

Review of services

Between 1st April 2018 and 31st March 2019, Mary Ann provided the following services:

Day Hospice

Hospice at Home (day and night)

Rapid Response (at night)

Complementary Therapy

Lymphoedema

Family Support – including bereavement

Motor Neurone Disease Coordinator

Professional Advisor - CASTLE (EPaCCS) Register – fixed term service

Mary Ann’s Clinical Development and Quality Sub-Committee (CDQSC) is a sub-committee of the

Board, which meets three monthly. The CDQSC receives quality metrics and activity reports, which

enables the group to review the activity and quality of care provided by all clinical services. The full

minutes are submitted to the Board of Trustees on a two monthly basis. A further CQC inspection is

awaited and the Hospice has reported specified activity and quality data information to WN CCG

quarterly throughout 2018-19.

Our participation in clinical audits

During 2018-19, Mary Ann did not participate in any national audits. Mary Ann does have a local

clinical audit programme which is reviewed and approved each year, through the CDQSC. Priorities are

selected in accordance with what is required by our regulators and any areas where a formal audit

would inform the risk management processes within Mary Ann. In 2018-19 the following audits were

proposed and where completed the results and subsequent actions required reported to the CDQSC:


Mary Ann completed all the above audits with exception of nurse prescribing due to the delay in

receipt of prescription pads – this has been carried forward to the next years audit programme.

Audit summary

Through the CDQSC meeting minutes, the Board of Trustees is kept fully informed about the audit

results and any identified shortfalls. Through this process, the Board receives assurance of the quality

of the services provided and the management of clinical risks.

Research

During 2018-19, Mary Ann has continued to be research active, and maintains a research register. In

particular Mary Ann has contributed to the following:

We continued to participate in the – the PLACE trial (Prevention of Lymphoedema after Axillary

Surgery by External Compression) – a national trial. Two patients remain receiving follow up as

per the research guidelines.


Our Hospice at Home team were invited, and accepted, to become an additional site in the

national “Optimal Services at Home - End of Life Care” – since joining the study we have

recruited 10 patients and carers by year end, being set a target of minimum 12 by June 2019.

The DCS in their voluntary capacity as Research Lead for the National Association for Hospice at

Home is a co-applicant on a three year national research study investigating optimal Hospice at

Home provision. Several articles have been published in a variety of clinical journals outlining the

progress of this study.

What others say about us

Mary Ann is required to register with the CQC and its current registration status is unconditional. The

CQC has not taken any enforcement action against Mary Ann during 2018-19.

Mary Ann is subject to regular inspections by the CQC. The last on-site inspection was undertaken in

August 2014, and reported January 2015. Mary Ann achieved an overall rating of “Good”. A Provider

Information Return was requested by CQC, completed and submitted in November 2016. In December

2016, two Trustee representatives of the Hospice Clinical Governance sub-committee undertook a

mock inspection. All subsequent suggested actions or ideas were responded to by the DCS and the

Clinical Services Team Leaders. (See page 1 of this report for an image of our CQC rating). An

additional Trustee inspection has been arranged for April 2019.

Data quality

In previous years, in accordance with agreement with the Department of Health, Mary Ann has

submitted a National Minimum Dataset (MDS) to Hospice UK (formerly to the National Council for

Palliative Care). However since April 2017 the submission of this data to Hospice UK is entirely

voluntary – Mary Ann have chosen to continue to provide this data.

A key activity data matrix and quality metrics dashboard is now well established and subsequently

discussed and reported through our Clinical Development and Quality Sub-Committee and ultimately

our Board of Trustees.


Information Governance Toolkit attainment levels

We have received the following response from our IT supplier George Eliot Hospital NHS Trust in

respect of Information Governance Assessment Report for 1st April 2018-31st March 2019:

Duty of Candour

Mary Ann takes our duty of candour very seriously. All clinical related incidents are reported through

Mary Ann’s accident/incident/near miss reporting system. The DCS is also Mary Ann’s nominated

“Freedom to Speak Up Guardian”. All staff, including volunteers, are encouraged and enabled to

report any accidents, incidents or near misses no matter how minor they may be to foster an open

culture of sharing and reporting. All clinical reports are evaluated and rated using a robust risk

assessment framework by the collective Senior Leadership Team, all medium to high risk reports are

discussed by Mary Ann’s CDQSC and ultimately reported to the Board of Trustees.

Patients and their carers have ready access to the Clinical Services Team Lead, Clinical Practice Lead

and Clinical Development Lead should they wish to discuss any concerns. The following table

demonstrates what WN CCG requires Mary Ann to report quarterly:


Learning from Deaths

In July 2017, the Department of Health and Social Care published an amendment to the NHS (Quality

Accounts) Regulations which added a new mandatory disclosure relating to ‘Learning From Deaths’.

Mary Ann’s core business is to contribute to the care of the local dying population and ultimately

whilst death is unavoidable, it is understood on occasions death is untimely or unexpected. The DCS

has been a contributory member of the WN CCG’s Mortality Oversight Group and subsequent to

contributing as a reviewer to WN CCG LeDeR programme – a national programme investigating the

deaths of people known to have a learning disability, now remains a point of contact to the CCG for

any specific cases.

There have been no additional considerations specified by NHS Improvement for non-NHS bodies to

include in this year’s Quality Account report (letter dated 17th December 2018).

Part 3 A review of quality performance

As part of the quality performance review, Mary Ann has chosen to present information from their

MDS submissions, which is the only Hospice activity information presently collected by Hospice UK on

behalf of Hospices nationally.

The figures below provide information on the activity and outputs in relation to care provided to

patients and clients and a short analysis of this data is provided for each service presented.

Quality markers and patient safety incidents are reported subsequently.

The data below demonstrates a 20% increase in the total number of patients receiving care from our

Day Hospice services to our previous year and how we continue to care for more non cancer diagnoses

than cancer. The average length of care - the number of days attended weekly throughout a 16 week

programme of care - is just under 13 days, this is exceptionally good given the overall ill health of our

patient group and is testimony to how much our patients appreciate this service.

There has been significant increase – 38% on previous year – of the total number of patients receiving

Hospice at Home care. The overall percentage of people remaining at home to die when receiving care

from Hospice at Home remains high at 91%. Interestingly though the percentage of non-cancer

diagnoses is not reflective of Day Hospice trend, which is surprising given the integrated and

synergistic service provision approach – although it is acknowledged the caseloads of each service are

very different. Indeed, the caseload and turnover of patients and families receiving Hospice at Home

continues to be very fast and is reducing year on year – this year’s average length of care episode

being reported as 8 days. Although not recorded it is also reported that patients identify themselves as

predominantly White British for both services.


DAY HOSPICE 2018-19 2017-18 2016-17

Total patients 210 175 147

New patients 78 67 105

% New patients 40% 40% 70%

Continuing patients 55 55 42

Re-referred patients 40 53 NR

Re-referrals in year 88 65 27

New patients 25 – 64 years 16 16 17



New patients over 85 years 17 8 17

All female patients 109 108 85

All male patients 101 67 62

All cancer diagnoses 70 65 77

All non-cancer diagnoses 140 108 70

% New patients with non-cancer diagnoses 60% 44% 64%

Day care sessions 243 251 253

Day care places 3645 3765 3795

Day care attendances 1941 1570 1645

Number booked attendances – did not attend 697 719 655

Deaths and discharges 167 134 178

Number of continuing patients at end of year 44 55 42

Average length of care (days attended weekly) 12.7 12.1 39.2

HOSPICE AT HOME

2018-19

2017-18

2016-17



% new patients 95% 94% 93%

Continuing patients 14 14 17

Re-referrals 0 0 0

New patients 16 -24 years 0 0 1




New patients over 85 years 54 54 42




All non-cancer diagnoses 67 52 54

% all patients with non-cancer diagnoses 25% 35% 28.5%


Deaths 194 163 162

Home deaths 176 146 133

Care home deaths 2 0 1

% home and care home deaths 91% 90% 93%

Average length of care 8 8.8 9.3


LYMPHOEDEMA

2018-19

2017 -18 2016 - 17



% New patients 78.1% 29.5% 34.1%

% New patients 16 - 24 0% 0% 0%

% New patients 25 - 64 46% 49.4% 46.9%

% New patients 65 - 84 50% 49.4% 48.4%

% New patients over 84 4% 1.2% 6.25%




Appointments (1 hour average) 3152 3536 3406

Support Group Attendance 45 97 127

Healthy Steps Attendance 477 411 587


The Lymphoedema service has been revised this year by introducing a more robust approach to self-

care and maintenance management. This has been especially helpful due to the exponential and

considerable increase in new patients accessing the service following negotiation to provide our care

on a temporary basis for people referred from University Hospital Coventry and Warwickshire NHS

Trust. Mary Ann has done so without increasing clinical establishment and has maintained high quality

of service provision evidenced by feedback received. Our team have been commended for their

outstanding efforts. Our support group is moving to a peer led group framework, not professional.


BEREAVEMENT Hospice 17-

18

Hospice 16-17

Hospice 15-16

Total service users 256 325 267

New service users 159 178 164

% new service users 62.1% 54.8% 61.4%

All female service users 208 234 194

All male service users 47 91 73

Total contacts 2355 2367 2291

Contacts per service user 9.1 7.2 8.6

Phone calls per service user 1.0 1.0 1.0

% of contacts which were group sessions 35.2% 39.7% 31.9%

Average length of support 9.6 months 70.0 132.0

Discharged 85 182 110

% discharged 33.2% 56% 41.2%

As this data has been traditionally reported a year behind the actual report year, this year we are also

providing a short summary of activity for 2018-19:

o 234 clients seen during this period (172 adults and 62 children)

o Median age bracket for adult clients was 25 – 64 years; average age for children was 10 years 2

months

o Over 2,200 bereavement sessions were carried out with an average of 9 sessions per individual

o 56% of clients were discharged in that time, with 68% of clients receiving services for less than

4 months

There has been a review of how Family Support and Bereavement services are being provided within

this reporting year and also how activity data is captured. A significant point to note is the considerable

reduction in the time frame which clients received support from 9.6 months to less than 4 months.

Reassuringly our client feedback does not indicate any impact on outcomes through this shift as

demonstrated by the below summary:

We wrote to 74 existing clients (adults and carers of children) asking for their views on the

service. We received 21 replies (28% response rate).

Rating our service on a scale of 1-10, with 1 being poor and 10 being excellent, on average

clients rated us 9.

The comments received were overwhelmingly positive with lots of lovely comments about the

staff and volunteers.


RAPID RESPONSE (AT NIGHT) END OF LIFE CARE SERVICE

WN CCG

RUGBY CCG

*Oct 18 onwards

Total home visits requested in month 1456 82

Total home visits carried out in month 1400 79

Total telephone support calls (no visit being required) 29 1

Total visits declined in a month (due to criteria) 12 1

Total number of individual patients seen in month 763 60

Timeliness

% visits within 30mins of call received 88% 20%

% visits within 30mins-2hrs of call received 12% 80%

% visits within 2+hrs of call received 0 0

Primary Intervention Delivered at Each Visit:

Pain & symptom management, incl. syringe driver 232 26

Pain & symptom management, not syringe driver 328 20

Personal care 35 1

Reduce patient and/or carer anxiety 116 4

Provide advice and information on EoL care 48 0

Relieve Blocked Catheters 471 18

Other 182 2

Verification of Death 152 8

Discharge Support (new category)introduced July 2018 26 0

Patient outcome from visit:

Patient remained at home 993 66

Patient died at home 144 8

Patient went to hospital – clinical need 8 0

Patient went to hospital/hospice/community bed – patient/carer preference

1 0

Other outcomes:

End of Life documentation:

ReSPECT in place - Yes 633 40

The service has developed quickly and in October 2018 included supporting Rugby area from 12mn

until 8am as a pilot project. This has led to a slight reduction in the number of people in north

Warwickshire receiving visits within 30 minutes of calling the service, however the commissioned

target time to respond with a visit is 2 hours which is achieved. WN CCG count all visits made to

patients with syringe drivers or blocked catheters as avoiding conveyance and admission to acute

hospital – so over 700 avoided episodes and ultimately reducing NHS costs.


National currency

For the core clinical services provided the Hospice has continued to capture the currency units likely to

be introduced by NHS England subsequent to a national Hospice pilot. The patient population profiles

in term of phase of illness are shown below:

OACC phases of illness

(Outcomes Assessment Complexity Collaborative*)

Hospice at Home Day

Hospice

Lymphoedema

Number of patients in stable phase 55 228 1372

Number of patients in unstable phase 17 15 47

Number of patients in deteriorating phase 88 14 13

Number of patients in dying phase 57 0 0

Number of carer support plans 168 Not recorded Not recorded

The above figures are accumulative caseload figures assessed at each quarter of the reporting year.

The phase of illness enables Mary Ann to capture at what stage of palliative and/or end of life care

each person may be in. Patients move between phases – not always in a linear mode, hence the

numbers may seem much greater than the total Hospice patient cohort. Given that the majority of

lymphoedema patients for example are not palliative it is not surprising that many of these patients

are “stable”. Similarly, a significant proportion of Day Hospice patients will be at a more stable phase

of the long term/palliative condition when receiving our care – this helps Mary Ann to prepare patients

and their families for their end of life care and discuss advance care planning wishes too. Hospice at

Home will by the nature of their service see the majority of patients, whom are dying or deteriorating,

and when patients start accessing the service many of them are close to dying but are stable before

they deteriorate and then become “actively” dying.

We have invested time in the last quarter of the year refreshing and training our teams in respect of

recording carer assessment and support plans.

*Palliative Care Outcomes Collaboration (PCOC) Assessment Toolkit. University of Wollongong, Australia: PCOC; 2012. As cited in the Outcome Assessment and Complexity Collaborative (OACC) 2015 and having been piloted in respect of NHSE palliative care funding initiatives.


Quality Markers and Patient Safety Indicators

INDICATOR 2017/18

Patient Safety Incidents

Number of Serious Patient Safety Incidents (excluding falls)

0 0

Number of Slips, Trips and falls 1 2

Number of Patients who experience a Fracture or other Serious Injury as a result of a Fall

0 0

Other Incidents Directly involving patients = 8 Total clinical related = 14

14 14

What patients say about the Hospice

How we capture feedback provided during episodes of care

Feedback is of course welcomed and encouraged all through the year, and to demonstrate our

commitment to providing opportunities for real-time monitoring the Hospice now uses

iWantGreatCare https://www.iwantgreatcare.org/ for all services with exception of Family Support

and Bereavement, who use a personalised evaluation at the start and end of each client intervention

episode as previously referred to in this report. Real-time monitoring is consistent with the

requirements of the fundamental standards of care and enables staff to take immediate action to

address any issues raised.

Below are just a few examples of hand written feedback we have received about our care.

INDICATOR

2018/19

2017/18

Number of Complaints (clinical) 2 1

Number of Complaints (non-clinical) 4 4

https://www.iwantgreatcare.org/


What our staff and volunteers say about us

Last year Mary Ann took part in the Hospice UK national Birdsong survey; this enabled Mary Ann the

opportunity to compare themselves to other Hospices across the UK. This year we are sharing some

feedback recently received from our staff and volunteers -


The DCS would like to thank all staff and volunteers who have given their feedback about their roles at

Mary Ann. Mary Ann also hosts a bi-monthly “I-Matter” forum which is a meeting for staff and

volunteers to talk about their roles, to support and encourage each other and work as well as to and

learn more about the work of Mary Ann.

Staff Turnover

Mary Ann has a vast volunteer workforce and paid staff headcount is kept to a minimum. The staff

turnover for 2018-19 is 18%, this figure is inclusive across the whole organisation including retail

where there has been considerable expansion. This figure is also inclusive of all zero hour contract

staff.

Like many other hospices, Mary Ann recognises the challenges of recruiting and retaining staff and

volunteers with key skills essential to care service delivery and the I-Matter forum is an excellent

mechanism for staff and volunteers to share their experiences and to feel valued and listened too.

Who has been involved with this report

The DCS has involved Mary Ann patients and carers, clinical and fundraising staff and volunteers, the

Clinical Services Practice Lead, Clinical Services Development Lead, Lymphoedema Specialist Nurse and

Family Support and Bereavement Coordinator in the first draft of this report. Subsequently the report

has been circulated to the Chief Executive Officer, Acting Chairman of the Hospice’s Board of Trustees,

and on 20th May to all Trustees and to the following Commissioners, local scrutineers and key partner

providers, inviting feedback by 24th June 2019 for inclusion in the final published report:

1. Warwickshire North Clinical Commissioning Group

2. Coventry and Rugby Clinical Commissioning Group

3. HealthWatch Warwickshire

4. Nuneaton and Bedworth Borough Council Overview and Scrutiny Committee

5. Warwickshire County Council & Public Health Warwickshire

6. North Warwickshire Borough Council

7. Nuneaton and Bedworth Borough Council

8. Coventry & Warwickshire Partnership Trust

9. George Eliot Hospital, Nuneaton

10. South Warwickshire NHS Foundation Trust

Mary Ann were delighted to receive formal responses from George Eliot Hospital NHS Trust, South

Warwickshire NHS Foundation Trust and Nuneaton and Bedworth County Council. The responses are

included on the following pages:


Annex

What others say about the organisation

#@maehospice

Registered Charity: 1014800

maryannevans.org.uk Mary Ann Evans Hospice

Eliot Way, Nuneaton, Warwickshire, CV10 7QL t. 02476 865440 e. [email protected]

Our Mission Statement Vision

Patients, families and carers in our community experience a journey towards end of life and into bereavement that is personalised, supported, comfortable, safe

and is in a place of their choice

Mission Mary Ann will provide comprehensive, high quality

support and end of life care across our community through all the services we provide to patients and those close to them

We will do this in partnership with others where appropriate

We are committed to training, supporting and encouraging our staff and volunteers to achieve our mission

Strategic Aims

Mary Ann will be recognised as being the lead provider for comprehensive and high quality community end of life care and support

Mary Ann will promote open attitudes in our community towards death and dying and provide bereavement support to all that need it

Mary Ann will maximise organisational impact through robust financial management and growing support of our community

https://www.instagram.com/maryannevanshospice/

https://www.facebook.com/MaryAnnEvansHospice91

https://twitter.com/maehospice

mailto:[email protected]

quality account 2018-19 · 2019. 8. 27. · the mary ann evans hospice (mary ann) underwent an...

Documents