Part 1Chief Executive S Statement on Quality 3

Quality Account

2016 - 2017

CONTENTS

Part 1Chief Executive’s statement on quality...... 3

Vision, purpose, values and strategic aims...... 4

Part 2Priorities for improvement and statement of assurance...... 5

2.1Priorities for Improvement 2017-18...... 5

2.1.1Reporting on Patient Outcome Measures...... 5

2.1.2Audit Research and Education...... 5

2.1.3Managing increasing referrals...... 5

2.2Achievement of priorities for improvement 2016-17...... 5

2.2.1Continue to develop a rehabilitative model of care across all Hospice services....5

2.2.2Advanced Care Planning...... 5

2.2.3Increase opportunities for patient, family, staff and volunteer feedback...... 6

2.2.4To further develop reporting on patient outcome measures...... 6

2.3Statements of assurance...... 6

2.3.1Review of services...... 6

2.3.2Participation in national clinical audits...... 6

2.3.3Participation in local audits...... 7

2.3.4Research...... 7

2.3.5Quality improvement and innovation goals agreed with commissioners...... 7

2.3.6What our regulators say about the Hospice...... 8

2.3.7Data quality...... 8-9

Part 3Review of quality performance...... 10

3.1 Governance Structure ………………………………………………………………………………………10

3.2Board of Trustees commitment to quality...... 11

3.3Comparison of Heart of Kent Hospice over a four-year period from

2011/12 – 2015/16 2016/17...... 11-12

3.4Feedback from patients and their relatives...... 12-13

3.5Clinical Complaints...... 14

3.6What staff say about the Hospice...... 14

Part 1 – Chief Executive’s statement on quality

I am delighted to introduce our Quality Account for 2016-17.

Heart of Kent Hospice provides specialist and individualised palliative care to the population of Maidstone, Aylesford, Tonbridge and Malling and surrounding villages. Our care is provided free of charge to 1,300 patients and families each year in their homes, in the community and in the Hospice. As an independent charity we are not part of the NHS but we work in collaboration with local NHS services. We receive a grant from the NHS which contributes to 16% of our annual costs.

Heart of Kent Hospice is committed to deliveringa high qualityand cost-effective service to patients and their families. We were delighted to receive an overall rating of Outstanding from the Care Quality Commission in February 2017 in recognition of our commitment to providing the very best care. This report highlights the actions we have taken to improve our services in the last year and our key priorities for the coming year.

The safety, experience and outcomes for our patients and their families is of utmost importance to us. Over the last year, we have developed our rehabilitative approach to care and ensured all our patients have the opportunity to discuss Advance Care Planning. We continue to seek feedback from patients, families, colleagues and volunteers and have successfully relaunched our Patient and Carer Engagement Group. Finally, we are continuing to progress our approach to measuring patient outcomes to enhance the quality of our care.

Together with our Board of Trustees, I would like to thank our team of colleagues and volunteers for their compassion andcommitment which enables us to provide outstanding care to our patients and their families over the last year.

I am responsible for overseeing the preparation of this report and its contents. To the best of my knowledge the information reported in this Quality Account is accurate and a fair representation of the quality of healthcare services provided by our Hospice.

Sarah Pugh

Chief Executive

June 2017Our vision, purpose, values and strategic aims

Our Vision

We aim for a time when end of life care and death is a positively supported experience for all

Our Purpose

We are here to provide skilled, high quality care to all those facing the challenge of a life-limiting illness. We aim to optimise quality of life, enable people to live with dignity, affirm their individuality and support those closest to them during and following this most difficult of times.

Our Values

Strategic Aims

Part 2 Priorities for improvement and statements of assurance

2.1 Priorities for improvement 2017-18

2.1.1 Reporting on Patient Outcome Measures

• Report on Patient Outcome Measures in line with the new Palliative Care Clinical Data Framework.
• Embed the use of measurement tools into practice ie KarnofskyPerformance Status Score, phase and spell of illness to inform MDT management.
• Develop an internal outcome reporting stream to use as a quality and improvement tool.
• Benchmark the Hospice’s outcomes against local and national services.

2.1.2 Audit and Research and Education

• Involve all services actively in an Audit Programme above and beyond the core clinical audits.
• Create an annual clinical audit report to be presented to the Board in March 2018.
• Engage with appropriate research projects suitable for the Hospice’s patients.
• Identify opportunities to increase the Hospice profile at local, national and international conferences, including Hospice UK and International Palliative Care Congress.
• Work in collaboration with local Universities to gain accreditation for the Hospice to deliver end of life modules on topics including Dementia and Long Term Chronic Conditions

2.1.3 Managing Increasing Referrals

• Review the Hospice referral criteria and create a framework to support patients being seen by the right person at the right time in the right place.
• Implement a Duty CNS / Triage approach to being responsive to referrals, patient needs and advice for Healthcare Professionals.
• Identify more efficient ways of working by inviting patients to attend clinics at the Hospice.
• Pilot joint working with a local GP practice to set up and run an outreach palliative care clinic at the surgery.
• Create an Active and Non-active caseload to manage patients at the varying phases of their illness.
• Increase accessibility and choice for patients by running a Wellbeing Programme in Magnolia Place Outpatient Centre.

2.2 Achievement of priorities for improvement 2016-17

2.2.1 Continue to develop a rehabilitative model of care across all Hospice services

• Arehabilitative approach is adopted in all clinical areas but particularly in Magnolia Place Outpatient Centre to support patients to remain independent with best possible quality of life.
• 100% of patients in Magnolia Place have set goals for attending.
• An enabling, empowering approach to promote independence is carried throughout all clinical services.
• A Wellbeing program was launched for Hospice patients early in 2017, the programme offers group sessions including Breathlessness and Anxiety Management and educational group sessions including Advance Care Planning and Nutrition.

2.2.2 Advance Care Planning

• All patients are given the opportunity to discuss Advance Care Planning (ACP), not all want to engage with this but by the end of March 2016 64 % had documented ACP on their Hospice electronic records.
• There is a culture where wesupport patients by understanding their likes, dislikes, preferences and wishes, evidenced by spot check audits showing 43% of patients have their likes dislikes and wishes recorded, and the introduction of the “Hello” document on IPU and CQC Inspection findings.
• The clinical teams continue to wherever possible support patients to die in the place of their choice, achieving on average80% preferred place of death each month.

2.2.3 Increase opportunities for patient, family, colleaguesand volunteer feedback

• New comments boxes are situated in reception, Magnolia Place and IPU with blank cards to encourage feedback from patients, visitors, volunteers and colleagues.
• All comments are recorded on a log and reviewed by the CEO and Patient Services Director and an action plan communicated where required. Each Head of Department logs adverse comments and affirmations and these are discussed monthly by the Clinical Management Team.
• A “You said… we did” display is updated regularly informed by patient, visitor, volunteer and colleague feedback.
• Quarterly complaints audits take place.

2.2.4 Further develop reporting on patient outcome measures

• Further iPOS (Integrated Palliative Care Outcome Scale) training is required to embed the use of the tool into practice and effectively report on individual patient and population outcomes.
• Monthly Key Performance Indicators are reported, including the data required for the new Palliative Care Data Set.This data is reviewed by the Patients Services Committee (Trustees) for Clinical Governance.

2.3 Statements of assurance

The following are a series of statements that all providers must include in their Quality Account. Some of these statements are not directly applicable to Hospices.

2.3.1 Review of services

During 2016/17 Heart of Kent Hospice supported the commissioning priorities for West Kent CCG by providing the following services:

• Inpatient care
• Community care
• Outpatient centre
• Occupational therapy
• Physiotherapy
• Complementary therapies
• Pre and post bereavement counselling
• Chaplaincy support

Funding provided by West Kent CCG represents 16% of our expenditure on charitable activities. £5m income is generated to fund our services annually, this balance is raised through gifts in a will, fundraising, events, corporate and community fundraising, grants from trusts and foundations, Hospice shops and lottery.

2.3.2 Participation in national clinical audits

As a provider of specialist palliative care, Heart of Kent Hospice is not eligible to participate in any of the national clinical audits or national confidential enquiries during 2016/17.

2.3.3 Participation in local audits

Local clinical audits were carried out at Heart of Kent Hospice in 2016-17. Internal clinical audits included:

• Infection Control
• Controlled Drug Audit
• Drug Incident Audit
• Complaints Audit
• Pressure Ulcer Audit
• Mobility & Safety Audit (Falls)
• DNACPR Audit
• FP10 prescription audit
• iPOS Audit
• Out of Hours Activity Audit
• Steroid prescribing
• Prescribing Audit

2.3.4 Research

No patients under the care of Heart of Kent Hospice during 2016-17 have participated in research that required approval by a research ethics committee.

There were no appropriate national ethically approved research studies in palliative care, which patients under the care of Heart of Kent Hospice were asked to participate in.

2.3.5 Quality improvement and innovation goals agreed with commissioners

The Hospice’s income from West Kent CCG in 2016-17 was not conditional on achieving quality improvement and innovation goals through the commissioning for quality and innovation payment framework because it was received in the form of a grant. The Hospice was required to submit quarterly data to the CCG including:

• Number of referrals and source of referrals
• Ethnicity, gender and age
• Percentage of cancer and non-cancer patients referred
• Number of community contacts, new, follow up and telephone
• IPU bed availability and occupancy
• Deaths: total on IPU, at home, and number of preferred place of care who stated a preferred place of care
• Number of continuing care patients
• Number of bereavement contacts
• Number of incidents including drug incidents
• Number of day therapy places, attendance and complexity
• Number of complaints and comments
• Number of individual services referrals and contacts

2.3.6 What our regulators say about the Hospice

Heart of Kent Hospice is registered with the Care Quality Commission and its current registration status is unconditional.

An unannounced routine inspection took place in February 2017. Heart of Kent Hospice is proud of its excellent reputation for providing palliative care to people across Maidstone, Aylesford, Tonbridge, Malling and the surrounding villages.

We are delighted that at this inspection the Hospice achieved an overall rating of Outstanding, this is credit to our dedicated teams who have worked exceptionally well on the action plan that has taken the Hospice from Requires Improvement in February 2016 to Outstanding In February 2017

Caring, they said “The service was outstandingly caring. People's feedback about the caring approach of the staff was overwhelmingly positive and emphatic terms such as, “exceptional", "remarkable", "amazing" and "outstanding" were used to describe them.

People were fully involved in the planning and review of their care, treatment and support while in the Inpatient Unit (IPU) and while receiving support in the community. Staff delivered care and support to people according to their individual plans.”

Effective, they said “Staff knew each person well and understood how people may feel when they were unwell or approached the end of their life. They responded to people's individual communication needs and treated them with genuine kindness and respect.”

Safe, they said “A new robust quality assurance system was implemented and embedded in practice. A range of audits and checks were carried out throughout the service to identify how the service could improve and action was planned and taken as a result.

All staff received one to one supervision to be supported in their role. All care staff were subject to competency checks to ensure they were competent to carry out their role.”

Responsive, they said “Specialist dementia care was provided by the service as an innovative response to the increase of dementia in the community.

The service sought feedback from people and their representatives about the overall quality of the service. People's views were listened to, valued and acted on. People and relatives’ comments were overwhelmingly positive about how

staff responded to their needs.”

Well-led, they said “The service was well-led. The service demonstrated considerable improvement. New systems and projects had been implemented and embedded in practice. The staff told us they had confidence in the current management team and were complimentary about the managers, the registered manager and the CEO's leadership style. There was a culture that focused on people and people were placed at the heart of the service.”

The full report can be found at

2.3.7 Data quality

In accordance with the Department of Health, Heart of Kent Hospice submits annual Minimum Data Set (MDS) returns to the National Council for Palliative Care, however as directed by the DOH this reporting system was stopped in April 2017.

Heart of Kent Hospice, as a specialist palliative care provider, does not submit data information to the Hospital Episodes Statistics because we are not eligible to participate in this scheme.

Heart of Kent Hospice has a dedicated Head of Information and Quality and continues to monitor its data through its monthly Clinical Management Meetings and clinical governance structure.

In 2016-17 we once again successfully met the Information Governance Toolkit requirements and the annual assessment we submitted was approved, achieving Version 14 – 75% - Satisfactory

This enables us to use NHS Connecting for Health systems and services such as N3. This will enable the medical and clinical teams at the Hospice to share and access relevant patient information in a secure manner and improve the overall coordination of care.

Part 3 Review of quality performance

3.1 Governance structure

to quality

3.2 Board of Trustees commitment to quality

The Board of Trustees is fully committed to the quality agenda. The Hospice has a well-established governance structure as outlined above with members of the Board of Trustees having an active role in ensuring the Hospice provides a high quality service in accordance with its Statement of Purpose.

The Board is confident that the treatment and care provided by the Hospice is of high quality and is cost effective.

3.3Comparison of Heart of Kent Hospice over a six-year period from 2011/12 – 2015/16

** Inaccurate data due to repetition in recording

*** During a change process and staff recruitment issues in Magnolia Place, attendance was reduced to three days per week, the data from Quarter 3 2015 will show a significant improvement and plans to open four days a week from January 2016

Overall during 2016-17 the Hospice cared for 1300 patients (2015-16: 1116).We cared for 646patients who died in 2016-17 (2015-16: 579).

IPU data has remained fairly static with bed occupancy slightly increased since last year.

The Outpatient Centre has seen an increase in referrals in 2015/16 by 62% in 2015/16 with an increase of sessions attended by 68%. As well as collecting this data we count daily “spaces” used by way of complexity i.e. 1 space = ambulant self-caring patient, 2 = requiring two to transfer and help with toileting, 3 = patients requiring hoisting and all care. This form of scoring informs staffing levels and attendance allocation.

Referrals to the Community Palliative Care Team have increased by 75% and new non-cancer patients by 32%, this rise in referral numbers has been impacted on by dementia patient referrals and the Hospice broadening its scope to care for all end of life patients irrespective of their disease or illness including elderly frail patients.

We have also chosen to measure our performance against the following metrics:

3.4 Feedback from patients and their relatives

During 2016-17 the Hospice carried out patient and carer surveys in the Inpatient Unit and Magnolia Place Outpatient Centre. The aim of the survey was to:

• Establish the views of patients cared for within the Hospice
• Gain ideas, suggestions and comments on how the service could be improved
• Encourage user involvement

Below are a selection of the questions and responses from patients and carers.

Below are a selection of the questions asked and responses from patients and carers. Yes and No answers.

The Hospice also participated in the FAMCARE survey 2016, this national survey was carried out by the Association of Palliative Medicine and completed by bereaved carers. In general, most bereaved carers were satisfied with the end-of-life care provided to their family member by the specialist palliative care service.