The Butterwick Hospice
at
Bishop Auckland
Quality Account
2014 - 2015
The Butterwick Hospice at Bishop Auckland
Woodhouse Lane
Bishop Auckland
Co Durham DL14 6JZ
Registered Charity 1044816
Our Mission Statement and Philosophy
Why we are here
We aim to improve the quality of life for those who have a progressive life limiting illness and those close to them and to offer positive support for every challenge they may encounter during their illness and to see death as part of life’s journey.
In particular we will:
Provide supportive and specialist palliative care for adults with progressive life limiting conditions
Ensure each person receives care in a homely environment whilst maintaining privacy, dignity and choice.
Provide holistic centred care by responding to and respecting the patient and those close to them by meeting their individual, physical, social, cultural, educational, spiritual and emotional needs throughout the illness and bereavement.
Acknowledge and respect the way those close to the patient care for them and endeavour to continue their chosen pattern of care.
Work together in developing an environment based on support and mutual respect.
Maintain the high quality of the service through ongoing reflection, evaluation and education.
Communicate effectively and efficiently both within the Hospice and with external agencies, to ensure continuity of care and promote service development.
Part 1: Chief Executive’s Statement
It gives me great pleasure to present the Quality Account for the Butterwick Hospice at Bishop Auckland in respect of the year ended 31st March 2015.
The Hospice is an integral part of Butterwick Hospice Care (registered charity 1044816) which provides services from three separate Hospices in the North East of England. All the Hospices’ services are provided totally without charge to our patients and their carers.
The day to day operational management of the Butterwick Hospice at Bishop Auckland’s clinical services are under the leadership of Mrs Paula Wood (Director of Patient Care and Service Development) who is designated the Registered Manager in the Hospice’s registration with the Care Quality Commission.
The Butterwick Hospice at Bishop Auckland endeavours to provide an excellence in evidence based palliative care for all patients regardless of age or diagnosis; to be a centre of expertise and a specialist resource within the community as a whole.
The needs of patients and their carers are paramount to the Charity’s existence and are the root and focus of all we do.
Quality is at the core of the Charity’s strategic and operational priorities.
An independent impartial assessment of the quality of care provided was obtained when the Care Quality Commission performed a routine unannounced inspection of the Hospice on 8th July 2014. Their Report showed that the Hospice was meeting all of the required standards. A copy of their full Report is available at:.
During the last year we have worked effectively in partnership with NHS Durham Dales, Sedgefield & Easington Clinical Commissioning Group and other partners for the benefit of the community we freely serve.
In the year the Hospice has achieved the Commissioning for Quality and Innovation (CQUIN) outcomes detailed in the 2014/15 Contract with the NHS Durham Dales, Sedgefield & Easington Clinical Commissioning Group.
The Charity only achieves its key objectives because of the professional skills, commitment and enthusiasm of our staff and volunteers.
I am responsible for the preparation of this report and its contents. To the best of my knowledge, the information reported within this Quality Account is accurate and a fair representation of the quality of healthcare provided by our Hospice.
Graham Leggatt-Chidgey
Chief Executive
May 2015
Part 2:Priorities for improvement and statements of assurance from
the board (in regulations)
- IMPROVEMENT
Within the Organisation quality is fundamental to improvement and accountability. The Board of Trustee’s continue to support and promote the ongoing development and improvement of services to ensure that the care and support provided evolves to meet patient and carer needs.
The priorities for quality improvement for 2015/16 are set out below.
These priorities have been identified in conjunction with patients, carers, staff and stakeholders. The priorities we have selected will impact directly on each of the three priority domains:
- Patient safety
- Clinical effectiveness
- Patient experience
a.Priorities for improvement 2015-2016
Patient Safety
- Priority One
For Health Care Assistants to complete the `Care Certificate` introduced by NHS England
in April 2015.
How was this identified as a priority?
The Care Certificate was created following the Cavendish review (July 2013) which was part of the response to the Francis inquiry into the failings of care at the Mid Staffordshire NHS Trust. The Cavendish Review highlighted that the training and development of Health Care Assistants was often not consistent or good enough. Cavendish proposed that a new certificate of Fundamental Care be introduced and this resulted in the Care Certificate.
The Care Certificate covers the learning outcomes, competencies and standards that must be expected from Health Care Assistants. It aims to ensure that all Health Care Assistants are trained to the same standard in order to provide care, compassion and a high quality of care in the workplace.
The Care Certificate is made up of 15 standards and encompasses the Code of Conduct for Healthcare Support workers, the Social Care Commitment and the 6C`s (Care, compassion, competence, communication, courage and commitment.)
The 15 standards which must be achieved are:
- Understanding your role
- Personal development
- Duty of care
- Equality and Diversity
- Person centred values
- Communication
- Privacy and dignity
- Fluids and nutrition
- Mental health, dementia and learning disabilities
- Safeguarding adults
- Safeguarding children
- Basic life support
- Health and Safety
- Handling information
- Infection prevention and control
The Care Certificate will provide clear evidence to employers, patients and people who receive care and support from the Hospice that the Health Care Assistants have been assessed against a specific set of standards and demonstrated that they have the skills, knowledge and behaviour to provide a high quality of care.
How will this priority be achieved?
Training sessions will be organised to inform all clinical staff regarding what the care certificate is, the reasons and methodology behind why it hasbeen introduced and what the Care certificate involves.
Supervisors are accountable for the decision to delegate care; therefore the supervisor should confirm that the outcome of any delegated task meets the required standard. Health Education England suggests that the supervisor should be a Registered Nurse.The Hospice Registered Nurses will therefore be identified asSupervisors. Training will be delivered to all the Registered Nurses in relation to what their roles are as supervisorsand how to complete observations of competencies and how to sign off when a competency has been completed.
Assessors are responsible for making the decision on whether the Health Care Assistant has met the standard set out in the Care Certificate. In order to be an assessor the person must themselves be competent in the standard they are assessing. The Hospice will identify Registered Nurses who hold a teaching qualification/student mentoring or preceptorship training. Training will then be delivered in relation to the role of the assessor.
The Hospice will introduce a system of standardisation which will incorporate the different assessors to meet regularly in order to review the evidence they have used to make a judgement. The assessors can jointly compare the quality, how much evidence was used; the type of evidence used and come to an agreement of what is sufficient. Guidelines regarding the assessment evidence will be agreed with the assessors.
How will progress be monitored and reported?
The nominated assessors will have regular meetings to review and sign off competencies/ standards.
There is a monthly Clinical meeting chaired by the Director of Patient Care and the clinical leads from all departments. The Care Certificate will form part of the agenda under education and all completed Care Certificates will be reviewed and agreed then certificates will be issued to the Health Care Assistants who have successfully completed the Care Certificate.
The clinical education database will be updated for Staff who have successfully completed the Care certificate. This will provide evidence to the Care Quality Commission as part of the inspection process.
A copy of the certificate will be sent to Human Resources to file in individual staff records.
Clinical Effectiveness
- Priority Two
To introduce the mental capacity assessment form within all
patient assessments
How was this identified as a priority?
All health and social care professionals have a statutory duty to abide by the Mental Capacity Act which became law in 2005 and there is a requirement to embed this into clinical practice.
There are 3 essential parts to this process:
- The professional’s opinion of the best care option based on their expertise and experience and tailored to the individual.
- The individuals understanding and opinion of the proposed care option, based on their wishes and feelings, beliefs and values. If the individual does not have the capacity for this decision then the understanding and opinion is carried out on their behalf following the process of best interests required by the Mental Capacity Act. This requires a series of checks to ensure that the decision is the one the individual would have made if they had capacity.
- The willingness to enter into dialogue between professional and individual to negotiate the option that is in the best interest of the individual.
The Deciding Right document (April 2014) was developed in the North East and was the first framework in the UK to integrate the principles of making care decisions in advance. All care decisions must come from a shared partnership between the professional and the child, young person or adult. Deciding Right provides the principles by which all health organisations can set their policies to encourage this partnership around care decisions made in advance for people who may lose capacity in the future. Deciding Right is based on the Mental Capacity Act and the latest national guidelines and has been approved by the NHS.
Although the Hospice promotes the Mental Capacity Act and all clinical staff have been trained and updated with the guidelines of the act as highlighted in the Deciding Right Framework the need for clear decisions and protocols during emergencies has to be balanced against the need to make decisions in advance that avoid unnecessary or distressing treatment Problems around these decisions are an individual and organisational risk.
The deciding Right Framework has developed a simple assessment form which can be used quickly prior to a decision made in relation to the individual’s care or treatment.
The Hospice will incorporate these assessment forms in everyday practice.
How will this priority be achieved?
Teaching sessions will be arranged for the Registered Nurses to attend to update them on the Deciding Right Framework and to inform the staff when a mental capacity assessment form should be used.
The mental capacity assessment forms will be kept within individual patient records to support the decision made of any clinical or medical interventions.
How will progress be monitored and reported?
TheMental Capacity assessment forms will be incorporated into the regular record keeping audits performed within the Hospice.
The results of these audits will be discussed in the Integrated Governance meeting held bi monthly attended by the Clinical Leads and bon clinical managers. Any action required following the audits will be highlighted and documented.
Any actions required following audits will befedback to the Clinical Leads who will then inform the clinical staff within individual departments of any outcomes or action required.
The minutes of the Integrated Governance meeting form part of the agenda items in the Clinical Governance and Strategy Committee which has trustee representation.
Patient experience
- Priority Three
To introduce the Child Bereavement Service Questionnaire within the
Family Support Team.
How was this identified as a priority?
A large proportion of the holistic services provided by the Hospice is bereavement support for adults and children. In order to continually improve services gaining feedback from service users is vital. There are various evaluation tools available to gain feedback for family support however there is none that are specifically designed to evaluate feedback from children who are accessing bereavement support. The Childhood Bereavement Network has been designing a tool specifically for the use by children following bereavement support.
The Child Bereavement Service Questionnaire (CBSQ) has been developed through a lengthy process of consulting, drafting, reviewing and piloting with children and young people, parents, and practitioners of child bereavement services across the UK.
The aim of the CBSQ is to evaluate the effectiveness of services for bereaved children by looking at changes in scores before and after accessing bereavement support. The child or young person is asked to complete the form. There are 3 versions of the form:
- Child form (for under 11 years old) with 6 questions
- Young person long form (for over 11 years old) with 38 questions
- Young person short form (for over 11 years old) with 15 questions.
The parent or carer is also required to complete equivalent forms.
As well as gaining valued feedback from the individual child or young person the CBSQ can also provide data on the effectiveness of the family support service.
How will this priority be achieved?
The Child Bereavement Service Questionnaire is licensed to the Childhood Bereavement Network. The Head of family support will contact the network to inform them that the hospice will be implementing their evaluation questionnaire.
Guidance notes will be issued to members of the family support team in relation to how to implement and review the Child Bereavement Service Questionnaire.
The family support team meet monthly. The Child Bereavement Service Questionnaire will form part of the agenda in order for any issues implementing the questionnaire can be highlighted and discussed.
How will progress be monitored and reported?
The pre and post completed questionnaires will be filed in clients notes and may be subject to auditing.
Quarterly evaluation reports will be produced comparing the initial average scores with the review average scores. In each case you would expect the score to increase from pre to post access of the service.
The results of the questionnaires will be discussed at the Integrated Governance meeting which has both clinical and non clinical representation. Any action plan following the evaluation will be agreed and circulated to the family support team to action.
The minutes of the integrated governance meeting forms part of the agenda in the Clinical Governance and Strategy Committee which has trustee representation.
2.2 Review of services
During 2014/15 the Butterwick Hospice at Bishop Auckland provided five key services:
- Hospice at Home
- Family support and bereavement service
- Neurological service
- Day Hospices across 4 sites
- Outpatients
We have reviewed all the data available on the quality of care in all of the above services.
Below are some comments from a patient evaluation based on the impact the Hospice has to quality of life.
‘Do you feel the involvement with the Hospice has had an impact on your quality of life?’
- “It enables me to get out and talk with other people with similar problems”
- “I feel I could not cope without the help received from all staff and volunteers. I would recommend the Hospice to others for support”
- “Someone to turn to, I would have no one else”
- “The Hospice has really improved my quality of life and given me sense of hope”
- “I really enjoy the Hospice. Friendly and always there to help you”
- “Mrs Butterwick, thank you from the bottom of my heart x “
- “Opportunity to talk to other people with same problems. More social interaction”
- “I am a new person. My family and myself feel we have had help and advice that has helped hugely. Thank you”
- “Helped to live with my loss and realise life is still worth living”
A patient’s experience of the Butterwick Hospice at Bishop Auckland
‘The Butterwick Hospice at Bishop Auckland’
I’d had a few months of not being well and was then given a diagnosis which was really scary. I had District Nurses, MacMillan visits and GP and Consultants and I was tired. It was suggested somewhere down the line that I visit the Butterwick Hospice for a day.” What me? A hospice? I have no intention of dying yet” was my reaction. Well, I was persuaded for one day to go – not keen but the suggestion was kindly meant. I was given comfortable, caring transport in the care of two wonderful gentlemen drivers, Txx and Pxxx – volunteers! Metat the hospice door by Nurse Axx with a warmth and friendliness so caring. Then shown around every area of the building by a long term volunteer, another Axx, all Axx’s are lovely. I was seated comfortably in the right sort of armchair for me, footstool if wanted and offered tea, coffee and scones. The seven or eight other patients, used to us new nervous people, smiled and waved over and soon we were chatting. Now in a hospice I’d thought all would be about how ill we are, what we had wrong and treatments etc. No, we are there to talk a bit, share the past week and then be just like any other group of people. Families, plans, social bits, interests – all sorts. A day passes veryquickly. Tea, coffee or juices whenever, delicious lunches cooked on the premises. Back in the lounge from the delightful dining room, more drinks and sweets on the many coffee tables. Now that’s the social type of things which is relaxed, homely and comforting. Meanwhile the nurses and volunteers don’t sit in an office somewhere, they are right there with us. Always available to listen, advise, and take part in whatever we’re doing and ready to step into a need. In the many side rooms, treatments are available from physiotherapy, chiropody, massage, lymphoedema clinics etc. We’ve had parties and pantomimes, bingo and quizzes; one volunteer will varnish our nails, another interest us in crafts and music. All have something to offer and do so generously. Did I infer that now I go every week – I do. A day of caring for me and a day to himself for my husband who deserves it.