John Taylor Hospice - NHS€¦ · New workforce database and professional assistance – Croner Establishment of a Freedom to Speak Up Guardian Identification of a Non-Executive Director

Quality Account 2017/18

John Taylor Hospice

John Taylor Hospice Quality Account - 2017/18 2 | P a g e

Table of contents

Part 1 - John Taylor Hospice statements .............................................................. 3

Part 2 - Values .................................................................................................................................... 5

Part 3 - Strategic aims ............................................................................................................... 6

Part 4 - Looking Back - What we achieved in 2016/17 .................................... 6

Part 5 - Looking Forward – What we aim to achieve in 2018/19 .......... 8

Part 6 - Quality Review ................................................................................................................. 9

Part 7 - External scrutiny ................................................................................................... 21

Part 8 - Statements from our stakeholders ...................................................23

Appendices ............................................................................................................................................. 25

Glossary ................................................................................................................................................... 26


Part 1 - John Taylor Hospice statements

1.1. Chief Executive Officer statement I am delighted to present on behalf of the Board of John Taylor Hospice, our Quality Account for 2017/18. This will be my third Quality Account since joining the hospice in 2016 and I am excited to see the developments and improvements we are making right across our services. It is reassuring to see that we have successfully achieved the priorities for improvement we set ourselves last year and have been a positive benefit for the patients and families we care for. We are committed to continue to look at what we do and see what further work is necessary to make sure our services are safe, effective and caring for those people who need our support and as such have set ourselves further improvement priorities for the coming year. We continue to be committed to working in partnership with our local stakeholders and commissioners and forge strong partnerships to ensure our local communities receive the care they need in the place that is most suitable for them. During the course of the year we were pleased to be a pilot site for the Hospice UK Open Up Hospice Care campaign which identified that one in four people who would benefit from hospice care are still not receiving it and we are passionate about trying to change that. As such we have increased some of our services during the year and have plans to do more in 2018/19. A great deal has been achieved in the last year and this has been as a result of the hard work and dedication of all our staff at the hospice and the consistent support of our volunteers and I would like to thank all of them for their commitment over the last 12 months which has undoubtedly assisted us to achieve all we have. 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 John Taylor Hospice

Penny Venables Chief Executive Officer


1.2. Statement from the Chair It gives me great pleasure to endorse the Quality Account for 2017/18 after another successful year for the hospice. High quality care remains the number one priority for the hospice and the board is committed to delivering this while constantly looking at what more we can do for our patients. Our reputation with the local population has been built up for over a hundred years and we continue to build on our relationships with commissioners and stakeholders to ensure we remain a key partner in the local health and social care economy.

As a board we continue to review our structure and governance to make sure we are adopting the best possible model to deliver the important services we do. As such, we have made the decision this year to convert the hospice from its current community interest company form to a charitable organisation. This new form is in place from 1st April 2018 and will help us to deliver our strategic plans and develop the hospice further. What we are clear on however is that, whatever our form, our commitment remains to provide the best possible care and support to our patients and their families.

Harry Turner Chair The following Quality Account covers the period up to April 2018 when the hospice was trading as a community interest company.


Part 2 - Values At John Taylor Hospice we are committed to providing the highest quality of care to our patients.

Each of us at John Taylor Hospice has a unique role to play in the future of this organisation. By working together we will demonstrate our commitment to the hospice values, to our patients and their families.

We believe our patients deserve nothing less than this. By continual engagement with our patients, staff and partners we will transform our organisation into one where continuous improvement is natural and self-generating.

The hospice values will help us to progress our vision, they are:

Building trust and improving relationships between professionals,

patients and carers so that opportunities to help and problems are

identified early. We identify on a day-to-day basis the practical

things that can be done to tailor our services to the individual,

leading to a more positive patient experience. We care about the

person and about each other.

Being friendly, generous and considerate. See the person in John

Taylor means making everyone (patients, visitors, relatives and

colleagues) feel special and cared for by going the extra mile.

Compassion is at the heart of what we do every day. We should put

people first in all that we do. It also means being respectful and

considerate to our colleagues.

Doing things once and doing things right. To do this you have to be

able to visualise where the business is going and understand how

what you do makes a contribution. Be right first time also means

working accurately and efficiently, cutting out rework and

reducing time spent on correcting mistakes.

Communicating in plain language that is relevant to the intended audience. Using terms that people in our care, colleagues and the public understand. Taking reasonable steps to meet people’s language and communication needs and, where practicable, providing assistance to those who need it. Ensuring that the communication is made at the right time.

Throughout 2018/19, our values will play a part in the governance of the hospice and will be linked into our appraisals and one to one discussions with staff. Our values will also be a key agenda item in team meetings to reinforce our message.

Care for all

See the person

Be right first time

Simplify the

complex


Part 3 - Strategic aims A new three year strategic plan has been developed and approved by the board, this can be found by clicking here, or alternatively on the hospice website. Our plan aims to build on the great work we already do to make sure we remain successful and have the opportunity to grow. However society around us is changing and demand for our services is increasing. We want to open up our services to more people and to do that we know we need to look at growing our income from a wide range of sources. All of our ambitions with regard to this are laid out in our strategic plan document.

Part 4 – Looking back at what we achieved in 2017/18

4.1. Priorities for 2017/18 We set ourselves a number of priorities for the last twelve months and this is what we achieved.

4.1.1. Tough Books in Community John Taylor Hospice successfully re-launched mobile working with an in-house managed system, fully compliant with technical requirements of NHS Digital during 2016/17. This has enabled our clinical staff to increase the number of patients they see as documentation can be completed safely within the patient’s home, minimising the need to return to base.

March 2018 saw the remaining clinical staff trained on how to use the new system which will enable them to see clinical records sooner to enhance patient experience and improve safety.

4.1.2. Being Open and Duty of Candour As a hospice, we are committed to the provision of high quality healthcare. As part of this objective, the hospice has a duty to limit the potential impact of clinical and non-clinical risks and put in place robust and transparent systems to make sure that all incidents are recorded, investigated and rectified through action planning.

Our objective for the year was to strengthen these processes and make sure we are open and listen to concerns about our services. As a result we have introduced the following systems and processes during the course of the year:

New Being Open and Duty of Candour policy

New incident reporting and risk computer system – Datix

New complaints process and procedure

New workforce database and professional assistance – Croner

Establishment of a Freedom to Speak Up Guardian

Identification of a Non-Executive Director as Being Open Champion

4.1.3. Service Improvements Service improvements for 2017-18 were planned for the Heart of the Hospice (Day Hospice) and Hospice at Home services all of which we have achieved. Our proposals were as outlined below. 4.1.3.1. Day Hospice

The Day Hospice has now been renamed the Living Well Centre following consultation with the patients who use the service. A specifically designed therapeutic 12 week programme has been implemented and this is evaluating very well, with the data collected helping inform future developments and publications externally. This new therapeutic 12 week multi-disciplinary programme of care focuses on living well with a terminal illness and addresses symptom control and supporting emotional, social and spiritual needs.

This service provides:

Support from professional staff, volunteers and the shared experiences of other patients

Symptom management

Individualised care with access to and involvement with JTH Multi-Disciplinary Team

https://www.johntaylorhospice.org.uk/assets/000/001/899/The_Way_Ahead__Our_Three_Year_Strategic_Plan_original.pdf


Relaxation skills and participation in gentle exercise with physiotherapists and occupational therapists

Activities for those who enjoy arts and crafts, painting and card and jewellery making

Informal discussion groups looking at issues relevant to the patients, for example planning for the future, understanding and managing medicines

Complementary therapies and acupuncture in line with the Acupuncture Association of Chartered Physiotherapists guidance

Carer support and education

Additional activities that patients choose and may fulfil really important wishes for them individually as well as the groups as a whole.

4.1.3.1. Hospice at Home Service Our goal in 2016/17 was to expand services to people we care for in their own homes as we know most people want to be with their families at the end of their lives. We did manage to expand our Hospice at Home community services from 08:00 – 20.30 and would like to expand further in the next twelve months if we can attract the funding.

The team now provides specialist nursing care to patients Birmingham-wide in their own homes, supplementing district nurse services, during the final phase of illness. JTH’s original objective was to expand the service to ensure Birmingham patients receive the best end of life care in the patients’ preferred place of care, this has been successful.

The team provides advice, support and meets personal hygiene needs. Our nursing team works alongside JTH’s Clinical Nurse Specialist Team and district nurse teams to provide specialist nursing care and management of symptoms as necessary.

4.1.5. Hospice Clinics Our fifth objective was the creation and implementation of two new clinics, these were:

Intravenous (IV) Medication Administration Clinic

Tissue Viability (TV) Clinic

Unfortunately due to the changes in the Day Hospice/Living Well Centre, the organisation has not fully implemented these clinics as planned but is hoping to in the next few months. Staff are in post and a tissue viability service is now provided throughout the hospice and for our community patients where required.

GPs have been contacted about the possibility of a wound clinic that can include treating fungating wounds, delayed healing of surgical wounds, infection, in addition to pressure ulcers and the management of other complex wounds that would facilitate patients feeling better for longer and reducing the need for acute hospital admissions. This has been well received and the clinics will commence shortly.

4.2. Performance against 2017/18 CQUIN target

During the 2017/18 period, we have been working with St Giles Hospice and Birmingham St Mary’s Hospice for this year’s ‘End of Life Care (EOLC) working together to strengthen the pathway’ CQUIN.

The aim of the CQUIN was to set out the following:

All hospices working together to scope and identify common themes (both positive and negative) across the health economy that are impacting on the quality of care and experiences for those in EOLC. Taking a particular look at common reasons for avoidable acute hospital admissions.

Providing expert analysis to help inform the CCG of provision gaps/weaknesses, future need, and good practices in end of life care.

Collating useful resources for the CCG to utilise, to inform all providers on how to ensure high quality end of life care for all.

JTH has successfully completed all four quarters of the CQUIN and is awaiting feedback from the CCG. The CQUIN has highlighted issues across the health economy and there are areas where hospices and


acute providers can improve patient experience by working more closely together. This work is beginning with a project around personal health budgets with Heartlands Hospital and admission reduction schemes including the extension of working hours within Hospice at Home. Relationships with local district nursing teams areas are being strengthened too so a more collaborative way of working is being created that reduces duplication of care and simplifies the journey for our patients.

Part 5 - Looking forward at what we aim to achieve in

2018/19 John Taylor Hospice has an exciting year ahead with new projects and service improvements that will ensure that patients in the community receive the best care when it is needed. We have highlighted five projects we hope to achieve in the coming year and linked them to the CQC Key Lines of Enquiry (KLOE).

5.1. Safe One of our key priorities for next year is the rollout and full implementation of an electronic incident and risk system - Datix. This will enable staff to quickly report any incident and to receive feedback directly. It will allow analysis of trends and more thorough management of actions and improvements taken following an incident or learning. The system will also assist with the provision of robust clean data to commissioners and other external bodies. It will save staff time, returning care time to patients by releasing staff away from administrative paperwork.

5.2. Effective Our key priority for next year to improve the effectiveness of our care is to fully understand our activity and to maximise efficiency within all clinical teams. This is complex and includes the development of a currency or value for each activity we undertake, down to the smallest detail. It will relate directly to activity and the care we provide and, whilst it is financial on first glance, the core of this piece of work is patient care and safety. By ensuring we make best use of our resources we can help the acute health sector and patients at the same time. Part of this is by offering additional services that may on the surface appear to be ‘niceties’. The well-being of patients and staff is often very difficult to quantify in financial terms and the organisation believes that living well for as long as you possibly can is a vital aspect of hospice care. The introduction of a dedicated complimentary therapy service across all areas of the hospice is therefore underway and it is hoped that this will be further expanded to help support staff later in the year. A dedicated complimentary therapy room along with a hair dressing salon is planned with staff recruited and in post and the service being created in conjunction with current patients.

5.3. Caring In order to enhance the care we offer to carers and relatives of our patients. A weekly carers’ session is planned within the Living Well Centre where there is space for carers to talk to each other and to gain support from the services available at the hospice including counselling, complementary therapy etc. Part of the session each week will be a teaching session on some aspect of care. For example many carers struggle with helping their loved one when they are in pain and simple guidance on how best to manage pain relief can make a real difference to their day-to-day life. There will also be help with benefits or financial advice if it is required. The support sessions are designed to try and minimise the burden of caring for their loved one.

5.4. Responsive

As a priority to improve our responsiveness to patients and their families we want to expand the inclusion of the local community in the work of JTH. There is a significant issue with loneliness and isolation within the wider community and a social day is under development where any member of the local community can attend the Living Well Centre, enjoy a three-course lunch and make friends or just


enjoy some company. It is hoped that some members of the group will consider volunteering at the hospice once they regain their confidence and this in turn will improve their well-being and reduce loneliness and isolation. The day is led by healthcare assistants and the group will enjoy all sorts of activities should they wish to take part, for example watching films together, gardening, crafts, quizzes and bingo. This raises the profile of the organisation within the local area and will assist with myths that exist that ‘hospices are where you go to die’. In part that may be true but in the main our focus is about living as well as you can for as long as you can.

5.5. Well-led During next year, we will work closely with our staff in order to improve recruitment and retention and become somewhere everyone wants to work. This work has several strands and includes:

Leadership and team building across all areas, mixing clinical and non-clinical staff

The rollout of new values which explain behaviours and expectations

To continue to develop teams who care about each other as well as the patients – and who are not limited by departmental boundaries but see the hospice as one big team who together provide excellent care every day for some extremely vulnerable patients and their loved ones.

Part 6 – Quality Review

6.1. Patient safety Patient safety is our highest priority. We have systems and processes in place to ensure our services are safe, caring and compassionate. We monitor quality using a number of metrics and processes.

6.1.1. Safety metrics reviewed The hospice regularly reviews a range of safety metrics as part of its governance processes, both clinical and corporate. In terms of clinical safety measures, these include safe staffing levels, reviewed on a daily basis, complaints and compliments, Central Alert System (CAS alerts), patient feedback, staff training and appraisals including revalidation, safeguarding and all company risks. These are reviewed at our Clinical Governance Committee each month.


Corporate safety measures include:

Housekeeping cleanliness audits to ensure a clean and safe environment is maintained.

Training records to ensure that staff are kept up-to-date and qualified including mandatory training and specialist palliative care training.

Internal and external audit programmes to monitor and maintain a safe environment for patients and staff.

Robust Incident and Risk Management - system in place to ensure that incidents and risks are proactively managed at the correct management and board level.

PLACE audit – annual patient-led audit organised and managed to independently assess several areas within the organisation.

Clinical dashboard with associated exception reports.

6.2. Safeguarding Safeguarding vulnerable adults is a process that protects patients from abuse by another person who holds a position of trust. Everyone has a right to feel safe and to live without fear of abuse, neglect or exploitation.

The Deprivation of Liberty Safeguards are an amendment to the Mental Capacity Act 2005.

During the 2017/18 period, we have reported eight safeguard concerns and four Deprivation of Liberty Safeguards (DoLS).

6.3. Internal and external audit We have a comprehensive company-wide audit calendar which informs designated staff from each directorate when an audit is due. Please see appendix 1 for our corporate audit calendar.

We have had a redesign of clinical audits which is led by the newly formed Clinical Audit Group (CAG). This group ensures that all clinical audits are completed, comply with changes in standards and ensure that actions are monitored. This group reports into the Clinical Governance Committee and is kept up to date via bi-monthly meetings.

6.4. Infection control 6.4.1. Hand hygiene We have implemented new Infection Control Audits from the Infection Prevention Society (IPS). These audits ensure the following areas are covered and monitored regularly:

Asepsis

Hand Hygiene

In-Patient Areas

Isolation Precautions

Peripheral Vascular Device Insertion

Urinary Catheter Insertion

Urinary Catheter Daily Care

Central Venous Catheter Continuing Care

Transportation of Specimens Standard Precautions

Peripheral Vascular Device Continuing Care

During the year it has become apparent that the use of central line audits is unnecessary as we have not had any patients with a central line in situ all year. These will be removed from next year’s audit calendar. There is also minimal use of peripheral vascular devices at present although this will increase in the Living Well Centre when the blood transfusion clinics are fully implemented. It is important to ensure we can evidence high standards of care whilst, at the same time, not burdening clinical teams with unnecessary paperwork.

6.4.2. External Heart of England Foundation Trust audit John Taylor Hospice underwent an annual external infection control inspection by Heart of England Foundation Trust (HEFT) resulting in compliance of a score of 97% being achieved. The audit is based on the standards set by the Infection Prevention Society (IPS) and it covers all aspects of infection prevention and control. HEFT provides the Infection Prevention and Control Nursing service to the hospice under a service level agreement.


6.4.3. Urinary tract infections (UTIs) All staff are aware of the importance of meticulous infection control measures, particularly hand hygiene and catheter care, due to the increased risk of developing infection.

The In-Patient Unit monitors patients for signs and symptoms of UTIs daily. The rate is very low and the definitive UTIs are treated with appropriate antibiotics if the patient is symptomatic. A positive specimen is not considered a UTI on its own, clinical signs and symptoms are very important in determining whether a patient has a UTI or is colonised with bacteria. Details of UTIs are submitted to NHS Digital Safety Thermometer on a monthly snapshot basis. This is a mandatory requirement.

Actions in place to reduce UTIs can be seen below.

Personal hygiene needs met

Increased fluids (if patient is able)

Catheter care

Hand hygiene

Antimicrobial stewardship

6.4.4. Rate of C-difficile infection John Taylor Hospice reports zero incidence of C-difficile during 2017-18 and there were no outbreaks of any kind identified during the year. John Taylor Hospice can also report zero outbreaks occurring in the reporting period.

6.5. Incident reporting

6.5.1. Serious incidents NHS England, Serious Incident Framework (March 2015) defines a serious incident as:

Acts and/or omissions occurring as part of NHS-funded healthcare (including in the community) that result in:

Unexpected or avoidable death of one or more people. This includes: suicide/self-inflicted death; and homicide by a person in receipt of mental health care within the recent past;

Unexpected or avoidable injury to one or more people that has resulted in serious harm;

Unexpected or avoidable injury to one or more people that requires further treatment by a healthcare professional in order to prevent: the death of the service user; or serious harm;

Actual or alleged abuse: sexual abuse, physical or psychological ill treatment or acts of omission which constitute neglect, exploitation, financial or material abuse, discriminative and organisational abuse, self-neglect, domestic abuse, human trafficking and modern day slavery where: healthcare did not take appropriate action/intervention to safeguard against such abuse

occurring; or where abuse occurred during the provision of NHS-funded care.

This includes abuse that resulted in (or was identified through) a Serious Case Review (SCR), Safeguarding Adult Review (SAR), Safeguarding Adult Enquiry or other externally-led investigation where delivery of NHS-funded care caused/contributed towards the incident.

We recorded one serious incident in the 2017/18 period which involved an information governance breach. All necessary parties were informed and were happy with the actions and increased procedures that were put in place.

6.5.2. Non-serious incidents We encourage all staff to report incidents. We investigate all incidents thoroughly, provide learning and education to staff and formulate an action plan to mitigate against similar incidents occurring in the future.


Between April 2017 and March 2018 there were a total of 191 incidents reported, 79.8% of which

resulted in no harm or were insignificant.

One incident was a major incident. This major incident was due to a delay in an MRI requested by

a JTH CNS staff member which resulted in the patient experiencing permanent paralysis. This

incident cause is due only to another organisation and is under investigation by them.

Please refer to section 6.5.4 for medication related

incidents, 6.5.5 for pressure ulcers and 6.5.6 for falls incidents.

Financial and information technology includes incidents relating to these functions. We use information about incidents, the cases, actions and processes involved as part of our evidence-base so that our constant improvements in patient care and safety are based on rational understanding of the practices and systems that make up our services. This chart shows breakdown of reports by directorate for each month.

Clinical and safeguarding includes all matters of safety and liberties. Corporate incidents includes aspects such as equipment, security, health and safety.

6.5.3. Never Events We record any Never Events through our incident reporting system.

Never Events are serious, largely preventable, patient safety incidents that should not occur if the correct preventative measures have been implemented. There are 25 explicit events considered as Never Events by the NHS such as wrong site surgery or wrong route administration of medication.

John Taylor Hospice recorded zero Never Events during the 2017/18 period.

6.5.4. Medication errors From April 1st 2017 to March 31st 2018 there were a total of 51 incidents involving medicines reported to John Taylor Hospice.


Lessons learnt/actions taken Incident reporting nationally suggests an increase in incidents involving Fentanyl patches with John Taylor Hospice reporting several in the last year. Most were found on admission from home or hospital


and were therefore attributable to another organisation. From 2017 hospice policy has changed and all incidents involving controlled drugs (CDs) attributable to another organisation are now reported directly to the CD Accountable Officer (CDAO) at the trust or organisation where the incident occurred, this change has been received positively by the CDAOs. Lessons learnt as a result of joint investigation have been reported in the secondary care newsletter to staff and they are now producing guidance for the use of Fentanyl patches for clinicians. Another incident has been included as a palliative care education resource for junior doctors. We continue to work together to reduce the risks of incidents and improve patient safety across the interface.

Good practice and sharing nationally In the previous year, two incidents were reported involving syringe drivers not working correctly or delivering medication as expected. These were thoroughly investigated at the hospice and subsequently reported externally to the MHRA. As a direct consequence, on 28th March 2018 the Government issued an urgent patient safety/medical device alert: “All T34 ambulatory syringe pumps – risk of unintended pump shutdown and delay to treatment alert reference (MDA/2018/010)” ensuring all organisations are aware and can take action to mitigate the risk to patients nationally.

6.5.5. Pressure ulcers From April 1st 2017 to March 31st 2018 there were a total of 32 Pressure ulcer incidents reported to John Taylor Hospice, these incidents include patients who were admitted to the hospice with pressure ulcer damage and those which were identified in the community. As explained in 4.1.5, we have staff in post and a tissue viability service which is provided throughout the hospice and for our community patients where required.

Pressure Ulcers Acquired

John Taylor Hospice has reported a total of 32 pressure ulcers (grade 1,2,3 & 4) with 25 of those being identified as present on admission. Seven pressure ulcers developed while patients were at the hospice. One of these was a grade 3 which was investigated via an RCA. No lapse of care was identified in any of the pressure ulcers. All preventative measures were put in place. Unfortunately part of the physiology of the dying process includes the breakdown of tissue and it is this process which will always require careful and skilled pressure area care as a fundamental part of care at the end of life. The hospice utilises specialist mattresses and other equipment as well as employing two specialist tissue viability clinical nurse specialists in order to minimise this risk as far as we possibly can.


6.5.6. Falls From April 1st 2017 to March 31st 2018 there were a total of 34 falls incidents reported at John Taylor Hospice. With two patients identified as falling with a minor categorisation, both of which did not happen due to a lapse in care.

Not relevant: No harm Insignificant: Minor incident requires first aid Minor: Incident requiring medical attention

Specialist equipment is available at the hospice and a falls risk assessment is utilised on the In-Patient Unit. Where necessary, a nurse is allocated to ‘special’ a patient at significant risk of falls. A falls group has been introduced to assist the organisation with meeting the NICE guidelines around falls, these were updated in January 2017.

A clinical dashboard was introduced in September 2017, this highlights a variety of clinical information and exception reports are submitted as part of the dashboard. There is a specific falls section included in the dashboard. Falls are split into four categories:

No harm

Minor harm

Moderate harm

Severe harm.

All falls are reported via the incident reporting system and are investigated accordingly. Once the investigation is complete, the fall is further categorised according to whether or not a lapse in care could be identified. So each fall is then categorised on the dashboard as ‘Minor harm – no lapse in care’ or ‘Minor harm – lapse in care identified’. Since September 2017 there have been 21 falls recorded with no lapse in care identified.

6.6. Venous thromboembolisms (VTEs)

We have experienced speciality doctors who assess each patient for potential venous thromboembolism.

During the 2017/18 period no patients developed a VTE whilst spending time here. Patients have been admitted with VTEs, however correct procedures were followed to ensure the patients received the correct treatments.

6.7. Safety Thermometer

JTH reports this data to the NHS Safety Thermometer which contributes to analysis for surveying patient harm and analysing results, this is a ‘snapshot’ audit of one day each month.

Please see Safety Thermometer graph below.


‘Harm’ can be classed as one of the following:

Pressure ulcer developed less than 72 hours of admission

Pressure ulcer developed more than 72 hours of admission

Fall (a fall that caused low harm or worse)

Catheter (catheter not replaced to scheduled renewal date)

VTE (a patient who has a new DVT, PE or other)

The Safety Thermometer is a ‘snapshot’ audit that is undertaken across all acute NHS hospitals on the same day at the same time. The hospice also takes part in this as it forms a part of the NHS National contract.

It is a useful tool when viewed in context but does not allow for trend analysis or clear information about harm that occurred at the reporting institution. For example, if a patient is admitted to us with a pressure ulcer and another with a UTI, these will both adversely affect our score in the Safety Thermometer audit despite the fact that neither harm occurred here. This gives a confusing picture and it is important that the context of the information is understood by the reader.

The most important element of the data is the harms that are recorded as occurring at the hospice. As we have a thorough audit process in place, trends, analysis and actions are put in place as required, the Safety Thermometer is purely a snapshot of information gathered in one four-hour period of the month.

During the period of April 2017 – March 2018, JTH can confirm that there have been two harms associated to John Taylor Hospice, one was a patient who developed a grade 2 pressure ulcer during their stay at JTH, the other was a patient who developed a UTI while an in-patient.


6.8. Patient feedback

6.8.1. Concerns and complaints We value all feedback and recognise complaints and concerns as an opportunity to improve service delivery and learn from lessons. During the reporting period, John Taylor Hospice has received eight formal written complaints.

6.8.2. Care Opinion and Healthwatch Birmingham We encourage patients and families to share feedback externally specifically on patient/family review websites. We have comment cards easily available on site at the hospice and staff also distribute them to patients and their families. External organisations we promote include:

Care Opinion https://www.careopinion.org.uk/

Healthwatch Birmingham https://healthwatchbirmingham.co.uk/

Both are independent websites where people are invited to review and comment on health services.

Recent posts include:

“The support which John Taylor Hospice gave my wife and myself was of the highest professional standards. But this was more than just being professional. There was genuine care across the whole

team and they should all be very proud of what they achieve on a daily basis. I will always miss my wife but the loving care, kindness and support that the John Taylor Hospice team gave both of us will

always be treasured.”

“We want to send our heartfelt thanks and appreciation for all that the hospice did for my wife and our mum. You gave 110% every day and with every interaction you had with her and us. She passed away

with dignity and much love and for that we will always be thankful. You did all you could for her.”

The hospice’s Brand and Media Team initially replies to each comment and shares any learning which may come from these comments. During the reporting period, we have received mostly positive comments on both Care Opinion and Healthwatch. All negative comments are encouraged to get in contact with the hospice to allow the organisation to improve its services for all service users.

6.8.3. Facebook Our Facebook pages are very busy and elicit many comments and reviews from patients, families, supporters and staff. We currently have more than 11,000 followers, many of whom are actively engaged.

The reviews section rates JTH 5* with a points rating of 4.9 out of 5. Posts featuring staff or an activity at the hospice will generate much support.

The comments we receive are either positive (praising the staff or services) or neutral (asking a question or stating a willingness to attend an event).

Examples of lessons learnt:

A review of the procedure of emergency admissions

Ambulance and stretcher familiarisation training to John Taylor Hospice staff

Training and event speakers on patients at the end of life with learning difficulties.

All John Taylor Hospice band 6 and above will attend the mandatory two day external advanced communication training

St John Ambulance service personnel working with John Taylor Hospice to become ‘Dignity Champions’

https://www.careopinion.org.uk/

https://healthwatchbirmingham.co.uk/


6.8.5. Patient satisfaction surveys Patients' views on the service we provide are extremely important to us. Our patient feedback process has been reviewed and all new patients now receive a patient satisfaction survey upon initial contact which is collected or returned anonymously after the third contact.

Patients are asked set questions for example: if staff at the hospice understand their concerns, helping the patient take control and showing care and compassion.

Feedback from these surveys will enable us to obtain a view of in-patient and out-patient experience across JTH, right down to individual specialist teams. The survey data results will feature in our Quality Account each year and this report will include details of the quality improvements that will be made due to the survey results and set the direction we intend to take to improve patient experience.

6.9. Research Service improvements have been presented at conferences throughout 2017-2018 at JTH, including:

John Taylor Hospice is recruiting a research post (7.5 hours per week) to take part in a portfolio study, this is being funded by (CRN) West Midlands.

The above research was published and presented at palliative care conferences.

The Clinical Team Research Group engaged with the West Midlands Research Network and has had success in gaining support from the NIHR (National Institute of Health Research). The team is now considering a dedicated clinician to lead with research.

Live:Moving Project

Three years ago a researcher from Birmingham University approached Jed Jerwood, the hospice art psychotherapist, about a film-based research project she wanted to apply for funding for, looking at ways to make more ethical films about vulnerable groups - one of which was people who have terminal illness.

Dr Michele Aaron developed the project, with support from Jed Jerwood, and partners from BCU, which became known as Life:Moving, which finally went live last year. Patients and their families from JTH took part in the project over a six month period, working in partnership with a filmmaker, Briony Campbell. The project involved giving film-making equipment and technical support to patients to make their own films, through workshops, rather than have films made about them. Briony supported the patients to create a range of different film responses to living with terminal illness. The research element of the project also involved developing ethical filmmaking guidelines for working with vulnerable groups.

The research was supported by the Arts and Humanities Research Council and the project was celebrated in a public view at St Barnabas Church in Erdington and Midlands Arts Centre last spring and Birmingham Repertory Theatre last autumn. Following the interest in the project, Michele and Jed were invited to present the project at the Hospice UK conference in November 2017 by the Head of Research at Hospice UK, Dr Sarah Russell. Over 900 delegates attended the conference and the Life:

Improving EoLC for People With Mental

Illness

Life:Echo

FAB: pharmacy technician led medication review

JTH - LGBT equality and diversity

Day Hospice - What do our patients

really want?

Clinical Pharmacists: Hands on in the

patient’s home at end of life

Pharmacy Students – Research studies

Improving ACP by understanding barriers faced by hospice staff

Using acupuncture to treat night flashes and sweating in patients with breast

cancer

Life:Moving exhibition

Benefits of communication workshops in hospice care

Introducing the Chatt Tool


Moving films were also shown in the exhibition hall for the duration of the conference. Jed and Michele have also presented the project at several regional conferences.

The impact of the project has also been felt internationally, with Dr Aaron and Briony Campbell attending conferences in Paris, Malta and other European cities.

Jed has also used the films to support teaching to 120 undergraduate nurses at Birmingham University - providing a day and half of the five day palliative and supportive care module which third years nursing students all complete. He has been invited back to teach this module again next year and will be using the films as part of the wider session on creativity in palliative and end of life care.

The legacy of the project has been far-reaching and continues - one participant died earlier this year and his friends wanted to include his film in his memorial celebrations. The project team is looking at a further funding bid to take the films to other countries next year. The project has had a positive impact in the patients and families who took part, the staff involved and for the hospice as an organisation, in terms of profile within the hospice world and beyond.

6.10. Workforce

6.10.1. Revalidation at JTH

6.10.1.1. Nurse revalidation Revalidation is the process that allows our trained nursing staff to maintain their registration with the Nursing and Midwifery Council. Revalidation demonstrates that our trained nursing staff have continued ability to practise safely and effectively.

Revalidation is a continuous process that trained nursing staff will engage with throughout their career. During the last twelve months the hospice has put together a revalidation programme that provides our staff will full support and leadership.

Our staff have full access to revalidation templates to evidence their continued professional development, along with two named nurses who complete the reflective practice evidence and two confirmers who check and sign of the completed revalidation folders.

6.10.1.2. Medical revalidation The NHS England Medical Appraisal Policy describes the framework for appraisal of licensed medical practitioners who have a prescribed connection to NHS England.

Currently there are three doctors with prescribing connections to John Taylor Hospice, both are up to date with their revalidation.

Furthermore all other doctors who work for the hospice (two doctors who form part of the out of hours rota) and have prescribing connections with other organisations have been revalidated by their organisations and this has been verified by the GMC website.

Our Responsible Medical Officer has been appraised by the Midlands and East Deanery.

6.10.2. Workforce engagement The 2017 staff survey was this year undertaken by Birdsong Charity Consulting. The benefit of undertaking this independent survey is that our results have been benchmarked against other participating hospices as well as Charity Pulse 2017. The survey was open for two months from June – August and 76 responses were received from JTH staff. This represented 69% of our workforce as at August 2017.

Whilst it is difficult to compare scores to last year’s survey as the format and questions are different, it is possible to look at the key areas required for improvement last year to compare how they have fared this year. It should be noted that the response rate to this year’s survey is impressive and, compared to last year’s response rate of 37%, represents a significant increase.


Top three scoring questions Score Hospice average

I understand what this charity wants to achieve as an organisation 93% 90%

If a friend or relative needed treatment I would be happy with the standard of care provided by this organisation

92% 96%

I enjoy the work I do 91% 94%

Bottom three scoring questions

Score Hospice average

Mitigation & Actions

Poor performance is dealt with effectively at

this charity 31% 35%

Values rollout and management training has begun to better equip our managers. Policies have been reviewed and workshops with managers have been led by the Director Of Corporate And Commercial Services.

Communication between different

teams / departments is effective

28% 35%

The organisation is currently going through a restructure to improve and streamlining processes. Several groups have been formed to increase communication including the clinical services forum. We understand more work needs to be done to ensure communication is robust for patient care.

Morale at this charity is high

20% 41%

Senior management are working towards developing a pay structure within the organisation. Values rollout is also underway and several drop-in sessions are available for staff to attend hosted by the Director Of Corporate And Commercial Services.

2018 will see the second year of the staff awards called Above and Beyond Awards (ABAs). Staff are asked to nominate colleagues and a panel will nominate awards across six key categories linked to our new company values.

The organisation continuous engagement with staff which includes:

CEO Brief which happens every two months and informs staff of the key messages from board.

Updated policies and procedures

Updated terms and conditions

Quality Circles continue to be a voice for staff to discuss key areas such as fundraising, communications and terms and conditions

A corporate induction which provides new starters with an overview of the organisation and key areas for discussion


Part 7 - External scrutiny

7.1. External data reporting

John Taylor Hospice provides data to NHS Digital, Unify2 and Hospice UK. Please see the varied list below which can be explained in more detail within the glossary:

Monthly Delayed Transfers of Care

Complaints

Hospice Benchmarking Data

Safety Thermometer

Information Governance Toolkit

PLACE

Central Alert System (CAS) John Taylor Hospice reviews all CAS alerts and responds to them in a timely manner. We

have a range of clinical professionals who respond and act on all alerts received by the hospice. Alerts usually involve pharmaceuticals/clinical equipment/estates.

All our care activities are logged electronically on our secure patient record SystmOne. We report on a quarterly basis to the NHS commissioners and also monthly to our own board on all activities delivered.

7.2. Birmingham Cross City Clinical Commissioning Group Birmingham Cross City Clinical Commissioning Group visits the hospice on a quarterly basis to review our clinical quality. An inspection was undertaken on 27th February. The report has been received and is currently under review, the verbal feedback given on the day was very positive.

We delivered one CQUIN in 2017/18 as reported earlier. In the previous Quality Account, it was reported that this year’s CQUIN would be a two year project, this however had been adjusted to be completed within twelve months.

For 2017/18, John Taylor Hospice will be implementing the most recent version of the Outcome Assessment and Complexity Collaborative (OACC) suite of measures. This is an outcome tool devised at UCL specifically for palliative care providers. It is recommended by Hospice UK and is already partly implemented at the hospice with two of the seven sections being undertaken.

A monthly report is submitted to the CCG which includes the clinical dashboard as well as an exception report. This offers assurance and is a true record of activity and issues that may have arisen during the preceding month.

7.3. Sandwell and West Birmingham Hospitals In April 2016 John Taylor Hospice successfully tendered for a Sandwell contract in conjunction with Sandwell and West Birmingham Hospitals. This involves two permanent ‘home from home’ beds located within JTH IPU. The aim of the service is to provide patients that are unable to remain at home with a supportive environment during the last days of their life, thus reducing the risk of an inappropriate admission to hospital.

7.4. PLACE audit

Annual PLACE audit was carried out in April 2017. The following results were recorded:

Area Result National Average Cleanliness 100% 98.38% Food 83.32% 89.68% Organisation Food 84.63% 88.80% Ward Food 82.51% 90.19% Privacy, Dignity and Wellbeing 85.10% 83.68% Condition Appearance and Maintenance 92.96% 94.02%


Area Result National Average Dementia 74.40% 76.71% Disability 81.64% 82.56%

A review of the assessment forms shows the following areas that did not meet the required standard for PLACE

In previous years PLACE participants have had the option to opt out of dementia assessment under certain criteria. JTH did not opt out.

The assessment of dementia-friendly environment is made up from separate questions within each area's assessment sheet.

7.4. Care Quality Commission John Taylor Hospice’s last inspection took place on the 25th May 2016.

A four person inspection team from the CQC consisted of one inspector, a member of the CQC medicines team, a specialist adviser who had experience of working as a nurse within the field of palliative care and an expert by experience. Our overall rating was ‘Good’. The full inspection can be found on the CQC’s website: http://www.cqc.org.uk/

http://www.cqc.org.uk/


Part 8 - Statements from our stakeholders

John Taylor Hospice Quality Account 2017/18

Statement of Assurance from Birmingham and Solihull Clinical Commissioning Group May 2018

1.1. Birmingham and Solihull Clinical Commissioning Group (CCG), as coordinating Commissioner

for John Taylor Hospice (JTH), welcomes the opportunity to provide this statement for inclusion in the Hospice’s 2017/18 Quality Account.

1.2. A draft copy of the Quality Account was received by the CCG on the 14th May and the review has

been undertaken in accordance with the Department of Health Guidance. This statement of assurance has been developed in consultation with neighbouring CCGs.

1.3. The Quality Account is presented in a reader friendly and accessible manner and clearly

demonstrates commitment to provision of patient focused high quality care. 1.4. The expansion of the service to include the wider community is a good initiative to enable a

greater understanding of how a Hospice works. 1.5. It is good to see that the majority of the 5 priorities that were set for 2017/18 have been

achieved, with the relaunch of Tough Books to enable agile working and therefore increasing the number of patients that can be seen.

1.6. It is also reassuring to see that there have been clear steps to improve transparency of service

with the introduction of several new policies to support the delivery of high quality care. 1.7. Extension of the Hospice at Home service has been implemented; it would have been useful to

understand the impact of the extension and how this has improved patient outcomes and access to the service.

1.8. It is clear to see from the priorities that have been set, that there was a strong drive to improve

the patient experience with the introduction of new services and the ambition to commence a complex wound clinic.

1.9. The CCG is pleased to see the progress against the CQUIN ambition, the joint working across

the Hospice has been beneficial, the ability to look at the positive and negative elements of the pathway have been useful for the commissioners, and the CCG has been able to distribute the educational links to key stakeholders.

1.10. There are five priorities that have been set for 2018/19 and it is reassuring to see that there is a

focus on how they will ensure that the services are safe, effective, caring, responsive and well-led. There is an ambition to develop systems and processes to improve clinical governance, alongside improving the recruitment and retention of staff.

1.11. It is positive to read the about the initiatives, systems and processes the Hospice has in place to

ensure that the service is safe, caring and compassionate. It would have been useful to expand on how external audit is utilised in order to offer further assurances for governance processes.


1.12. It is reassuring to see that the infection prevention standards have had external scrutiny and achieved a high score from the audit that was conducted.

1.13. The level of serious incidents reported is low, and the Hospice has outlined the one incident that was reported. It would have been helpful to understand what actions and increased procedures were put in place to prevent the incident from occurring again

1.14. The incidence of acquired pressure ulcers is low; in relation to the one pressure ulcer that was attributable to the Hospice, no lapses of care were identified. This reassures the CCG that good risk assessment practices are in place to prevent the development of acquired pressure ulcers.

1.15. From the data presented with regards to patient feedback, it is clear that lessons learnt have been implemented, this assures the Commissioners that the Hospice has a positive approach to patient feedback that is valued.

1.16. The CCG is pleased to see the results and response rate from the workforce has improved and there are clear actions and mitigations set out for the areas of improvement.

1.17. As Commissioners we have worked John Taylor Hospice over the course of 2017/2018. We are committed to engaging with the Hospice in an inclusive and innovative manner and are pleased with the level of engagement from the Hospice. The CCG recognises there have been significant changes for the organisation and some of these changes still require a period of embedding, further recognising that there is a strong commitment from the leadership and management team to make these changes a success. We hope to continue to build on these relationships as we move forward into 2018/2019.

Paul Jennings

Chief Executive


Appendices

Appendix 1 – Audit Calendar

Examples of audits undertaken at JTH: Statutory financial audit of the charity

Asepsis

HH Tech, Environment and Observation - IPU

Inpatient Areas - IPU

Isolation Precautions

Peripheral Vascular Device Insertion

Peripheral Vascular Device Continuing Care

Urinary Catheter Daily Care

Urinary Catheter Insertion

Central Venous Catheter Continuing Care

Standard Precautions

Transportation of Specimens

Pressure Ulcer Prevention

Nutritional Audit

Falls Prevention

HH Tech, Environment and Observation - LWC

In-patient Areas - LWC

Standard Precautions

Pressure Ulcer Prevention

Nutritional Audit

Falls Prevention

General Medicines

Controlled Drugs

Self-Administration of Medicines

Missed Dose

Use of Patients Own Drugs

Non-Medical prescribing Audit

Pain Assessment and Analgesic Effectiveness

Medical Gases – Clinical

Medicines Security

Documentation Audit


Information Governance Spot Check

COSHH

Door Security Access System

Waste Audit

Waste pre acceptance audit

PLACE LITE

PLACE

Monitory Housekeeping Audit

Environmental Audit - Clinical

Environmental Audit - Non-Clinical


Glossary

ACP

Advance Care Planning (ACP) is a voluntary process of discussion about future care between an individual and their care providers, irrespective of discipline. If the individual wishes, their family and friends may be included. It is recommended that, with the individual’s agreement, this discussion is documented, regularly reviewed and communicated to key persons involved in their care

CCG

Clinical commissioning groups (CCGs) are NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in England.

Central Alert System

The Central Alerting System (CAS) is a web-based cascading system for issuing patient safety alerts, important public health messages and other safety critical information and guidance to the NHS and others including independent providers of health and social care.

Alerts available on the CAS website include safety alerts, drug alerts, Dear Doctor letters and Medical Device Alerts.

Community Interest Company

A CIC is a special type of limited company which exists to benefit the community rather than private shareholders. As such, it makes a legal promise stating that the company’s assets will only be used for its social objectives, setting limits to the money it can pay to shareholders.

Complaints

The NHS complaints procedure is the statutorily-based mechanism for dealing with complaints about NHS care and treatment and all NHS organisations in England are required to operate the procedure. This annual collection is a count of written complaints made by (or on behalf of) patients, received between 1 April 2017 and 31 March 2018 and also includes experimental information on upheld complaints.

CGC

Clinical Governance Committee (CGC) is a system through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.

CQC

Care Quality Commission, more can be seen in the KLOE section in the glossary below.

CQUIN

Its full name is a Commissioning for Quality and Innovation payments framework and was set up by NHS England as a way of encouraging care providers to share and continually improve how care is delivered and to be open about overall improvement in healthcare. CQUINS take the form of agreements between care providers and their NHS commissioners for the care provider organisation to make changes that have a direct improvement on the quality of patient care for which the care providers receives payment when those changes are fully made.

DoLs

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom.

Duty of Candour

This became a regulatory requirement in November 2015 to ensure that care providers are open and transparent with the ‘relevant people’ when certain incidents occur in relation to care and treatment. It


is a direct response to the Francis Inquiry report into Mid Staffordshire NHS Foundation that defines the duty of candour as ensuring that:

…any patient harmed by the provision of a healthcare service is informed of the fact and an appropriate remedy offered, regardless of whether a complaint has been made or a question asked

about it…

EoLC

End of life care (EoLC) is the care experienced by people who have an incurable illness and are approaching death. Good EoLC enables people to live in as much comfort as possible until they die and to make choices about their care.

GMC

The General Medical Council (GMC) is a public body that maintains the official register of medical practitioners within the United Kingdom. Its chief responsibility is ‘to protect, promote and maintain the health and safety of the public’ by controlling entry to the register and suspending or removing members when necessary. It also sets the standards for medical schools in the UK. It is a criminal offence to make a false claim of membership. The GMC is supported by fees paid by its members and it became a registered charity in 2001.


The IG Toolkit is an online system which allows organisations to assess themselves or be assessed against Information Governance policies and standards. It also allows members of the public to view participating organisations' IG Toolkit assessments. Read more

HEFT

Heart of England NHS Foundation Trust (HEFT) includes Birmingham Heartlands Hospital, Solihull Hospital and Community Services, Good Hope Hospital in Sutton Coldfield and the Birmingham Chest Clinic.

JTH

John Taylor Hospice

Key Lines of Enquiry (KLOEs)

The CQC has established a review process in which adult care services are inspected around five key questions which inspectors use to help establish whether a service is providing the high standard of care expected of them. The five key questions are as follows. Is a service:

Safe? Effective? Caring? Responsive? Well-led?

NIHR (National Institute of Health Research

National Institute for Health Research funds health and care research and translates discoveries into practical products, treatments, devices and procedures, involving patients and the public in all their work. NIHR ensure the NHS is able to support the research of other funders to encourage broader

investment in, and economic growth from, health research. NIHR works with charities and the life sciences industry to help patients gain earlier access to breakthrough treatments and to train and develop researchers to keep the nation at the forefront of international research.

Never Events

Never Events are serious, largely preventable patient safety incidents that should not occur if the correct preventative measures have been implemented. There are 25 explicit events considered as Never Events by the NHS such as wrong site surgery or wrong route administration of medication.

https://www.igt.hscic.gov.uk/resources/About%20the%20IG%20Toolkit.pdf


Incidents are considered to be Never Events if there is evidence that the event has occurred in the past and is a known source of risk or if there is guidance which if followed would prevent a Never Event. Not all Never Events necessarily result in severe harm or death.

PLACE

Every patient should be cared for with compassion and dignity in a clean, safe environment and where standards fall short, they should be able to draw it to the attention and hold the service to account. April 2013 saw the introduction of PLACE which is the new system for assessing the quality of the patient environment in hospitals, hospices and day treatment centres providing NHS funded care.

QGC

Quality Governance Committee - QGC oversees the Clinical Governance Committee, Information Governance Committee and Health and Safety Forum.

RCN

The Royal College of Nursing represents nurses and nursing, promotes excellence in practice and shapes health policies.

RGN

Registered General Nurse is a nurse who has completed a three-year training course in all aspects of nursing care to enable the nurse to be registered with the Nursing and Midwifery Council. (NMC).

Safety Thermometer

The NHS Safety Thermometer provides a quick and simple method for surveying patient harms and analysing results in order to measure and monitor local improvement and harm-free care over time.

From April 2015 data collected using the NHS Safety Thermometer is included in the NHS Standard Contract under Schedule 6B.

Serious Incidents

The NHS defines a serious incident as one which resulted in one or more of the following:

The unexpected or avoidable death or severe harm of one or more patients, staff or members of the public.

A Never Event – See ‘Never Event’.

A situation that prevents an organisation’s ability to continue to deliver healthcare including data loss, property damage or incidents in programmes like screening and immunisation where harm potentially may extend to a large population.

Allegations or incidents of physical abuse and sexual assault or abuse.

A loss of confidence in the service, adverse media coverage or public concern about healthcare or an organisation.

Urinary Tract Infection

A urinary tract infection (UTI) is also known as acute cystitis or bladder infection. It is an infection that affects part of the urinary tract.

Venous Thromboembolism

Venous thromboembolism (VTE) is a condition that includes both deep vein thrombosis and pulmonary embolism. A deep vein thrombosis is the formation of a blood clot in a deep vein and the most serious complication is that the clot could dislodge and travel to the lungs, becoming a pulmonary embolism.

Documents

John Taylor Hospice - NHS€¦ · New workforce database and professional assistance – Croner Establishment of a Freedom to Speak Up Guardian Identification of a Non-Executive Director