Quality Account

2014 -2015

‘My son was only with you for a very short time, but it was made a special time for him, which in turn enabled me to become his mum again. He lost his battle with cancer. Your carers were able to bath him and he also had his last meal of roast lamb and mashed potatoes which, may I add, was his favourite. Also his words “try this mum it’s banging”. Many, many thanks to your very special team; thank you just doesn’t seem enough’

From a patients mother (May 2015)

St Luke’s Hospice

Nethermayne

Basildon

Essex

SS16 5NJ

Registered Charity No. 289466 and as a Company in England No. 1812104

Introduction

Chief Executive Statement

St Luke’s Hospice strives to deliver the highest level of palliative and end of life care to support patients and their families.

Services continue to be extended to ensure that the needs of the individual are met and that care can be delivered in a range of diverse settings to meet specific patient need and deliver choice wherever and whenever possible.Our aspiration is to enhance the patient experience and deliver clinical effectiveness within safe and secure environments.

Services are designed to address unmet need and to this end service user experiences and clinical knowledge are explored to structure and determine service design via a range of focus groups and projects or the Hospice User Group.

The Hospice is committed to collaborative and partnership working where the evidence is such that patient benefit and efficient resource deployment can be achieved and this has been very much in evidence with new service developments and future plans ensuring fully integrated care delivery.

The Hospice is working with commissioners and other providers to explore opportunities for collaboration and improved integration of services to enhance the patient experience, maximise specialist expertise, and to deliver cost effective service delivery.

The commitment and dedication of staff and volunteers across all services contributes to the success of the organisation and is totally supported by the local community, NHS Commissioners and other funding organisations who continue to support our work.

I am responsible for the preparation of the Quality Account for 2014/15 and to the best of my knowledge the information reported is fair and accurate.

Eileen Marshall

Chief Executive

June 2015

Part 1.

Reflecting on priorities identified for 2014/15

1. Establishing a dedicated Single Point of Access

November 2014 saw the launch of the charity’s OneResponse Service on a pilot basis. The service presents a fully integrated service model, which provides support, assessment and advice. Developed in partnership between the Hospice, and South West Essex Community Services (NELFT), particularly the Community Macmillan Team, and Community End of Life Care Team, the service aims to support patient choice, avoid inappropriate hospital admissions and enhance quality of care by working closely with acute services and providing a single contact number and reference point for patients, families and professionals. This includes a 24/7 Rapid Response Service to support patients and families at home or in a nursing home, as well as offering relevant support and advice to professionals.

Demand for the service has been high since initial commencement. The service has received a total of 10,000 calls, resulting in 2,721referrals (contacts) with a minimum of 215 hospital admission avoidance and 577 Rapid Response visits within two hours and has enabled on-going statutory funding for a further year. Fully embedding the service will be a key development for 2015/16.

‘Thank you for the support with the care of our mum. Without your service we wouldn’t have been able to care for her at home. Knowing you were at the end of the phone gave us all such peace of mind. Thank you for providing such an amazing service’.

Out Patients

Within the last year, with the benefit of improved accommodation, the Hospice has been able to build on the existing provision of outpatient clinics to increase services across a range of interventions. Such expansion has not only assisted in extending care to other illness groups but also provides an opportunity to demystify the concept of hospice services and facilitate greater understanding and opportunity to access other integrated and therapeutic specialist support.

Growth has been seen both in outpatient clinics and access to clinical tests, with clinics for COPD, palliative heart failure and breathlessness now well established.

Work to continue to raise awareness and develop relationships with healthcare professionals has also increased.

Arising from this a ground breaking initiative to improve palliative care support to patients with AdvancedLiver Disease has been developed. The project operates in conjunction with colleagues at Basildon and Thurrock University Hospital (BTUH) and provides a shared pathway between Hospital and Hospice to offer a seamless ‘one-stop’ service, with access to a range of support services and interventions to enable optimum well-being as well as enhanced emotional support to patients and their families.

The service will address a nationally acknowledged gap in service provision and could ultimately be held as a model to extend such care across the country. There has been national interest already.

Within the Hospice’s In-Patient Unit there was a 16.5% increase in patients admitted for procedures in ascetic drainage. Additionally a number of patients were admitted as day cases and short stays – (an increase of 67% on last year), with treatments and procedures performed within a shorter time than that traditionally associated with a hospital stay, thereby enabling savings within the local health economy.

The ability to receive treatments within the comfortable surroundings of the Hospice has proved very popular with patients; many of whom have felt empowered to self- refer for subsequent sessions.

The partnership project will be developed further during 2015/16 and application has been made for a grant to sustain and develop this initiative.

‘I have nothing but praise to give, the staff are first class, it has given me confidence’

Increasing Access to Lymphoedema Management

The full transfer of South Essex Lymphoedema Service (SELS) has enabled the opportunity to effectively utilise resources to enable service growth and development - including interventions for Primary Lymphoedema.

Clinics are now established in a range of localities to enable ease and equity of access for patients across South Essex.

Activity levels have increased, including to patients with Lymphoedema secondary to chronic conditions other than cancer.

The uptake of Primary Lymphoedema care is now funded by all CCG’s within South Essex and avoids the need for patients to travel to London hospitals, thereby improving the patient’s experience of care which is afforded within the locality.

‘As lymphoedema can only be controlled and not cured you sometimes feel depressed, helping to manage the condition is definitely a great help’.

Part 2

2.1Statements of Assurance from the Board

Review of services

During 2014/15 St Luke’s Hospice provided the following services:

  • OneResponse – Support Assessment and Advice Service
  • Fast Track Care (limited pilot)
  • In-Patient Unit
  • Day Hospice
  • Out Patients
  • Hospice at Home & Personal Care Team
  • Counselling Services (Adults)
  • Counselling Services(Children and Young People)
  • Lymphoedema Services, including non-cancer and primary, across South Essex
  • Specialist Physiotherapy Service
  • Social Work Service
  • Complementary Therapy Service
  • Information Resource Service and Information Centre
  • Quality and Education Service
  • Carers Support

The Hospice has reviewed all the data available to them on the ‘quality of care’ in all of these NHS services.

The income generated by the NHS services reviewed in 2014/15represents 47%of the total income generated from the provision of NHS services by St Luke’s Hospice for the reporting period 2014/15.

2.2 Participation in clinical audits and research

Palliative Outcome Score (POS and POS-s)

The Palliative Care Outcome Scale (POS) is a resource for palliative care practice, teaching and research. POS is a tool to measure patients’ physical symptoms, psychological, emotional and spiritual needs, and provision of information and support at the end of life ( It is a validated instrument that can be used in clinical care, audit, research and training. It is a tool which is recognised internationally.

POS-s is an additional tool which is used alongside POS to capture more information about symptoms.

The first Palliative Outcome Score (POS) and Palliative Outcome Score-s (POS-s) was carried out in 2014 and showed that both were well-embedded within Day Hospice, with identified themes which were used to further develop Day Hospice and Out Patient Services.

POS and POS-s were re-audited in 2014.POS and POS-s are now used routinely to measure effectiveness of interventions at St Luke’s and this is now supporting much of the anecdotal evidence that shows that prompt admission and reduced length of stay has significant impact on quality of life for the liver patients.

Advanced Liver Disease

(A collaborative pilot project between St Lukes and BTUH)

This audit aimed to:

  • To show the depth of services being accessed by patients with liver disease and their families at St Luke’s Hospice
  • To show how collaborative working has improved the quality of life of many of the project participants by reducing hospital admissions; enhancing patient experience and improving outcomes
  • To test and learn from a shared care model that embraces and promotes hospice care much earlier in the disease trajectory, therefore harnessing expertise from both specialities
  • To develop strategic planning to ensure future development and funding of this project.

Summary and findings:

  • To date 20 patients have been referred from the Liver team at BTUH to St Luke’s Hospice. The majority of these patients are triaged by the Liver Consultant or Liver CNS as being appropriate for referral to St Luke’s Hospice
  • The majority of the 20 patients referred to St Luke’s have been assessed by the SNP using a holistic assessment approach. Following this assessment interventions and signposting to other hospice services has followed.

Paracentesis

Early in the project it became apparent that drainage of ascetic fluid (Paracentesis) was problematic for this group of patients. The pathway was complex and often meant a protracted hospital stay which impacted significantly on quality of life for this patient group. Paracentesis has therefore been highlighted as an important area to address. Where possible St Luke’s is now offering an IPU service which has shown that average length of stay (ALoS) is reduced from 6.5 days to 1.5 days at St Lukes (based on hospital baseline data).

This is a new pathway which has not received funding to date. The pathway has been developed in response to a need and in order to develop a model which would enhance patient experience, introduce hospice services more proactively and reduce unnecessary and unwanted attendances to A & E and or hospital admissions. The impact on length of stay has reduced costs and enhanced pathways across the whole system.

2.3 Quality Improvement and Innovation Goals Agreed with our Commissioners

A proportion of St. Luke’s Hospice income in 2014/15 was conditional on achieving quality improvement and innovation goals agreed betweenthe Hospice andBasildon and Brentwood and Thurrock CCG’s.

The aim of this CQUINwas to improve end of life care provision through specialist training in identification of end of life, preferred priorities of care/death and individualised care plans. This included an increase of those on the electronic end of life care register.

The Hospice has a range of related in-house and external training which covers all domains relating to palliative care and end of life care such as communication in difficult situations, including breaking bad news, completion of PPC and Holistic Needs Assessment which incorporates individualised care planning.

During the year there was an increase in numbers of people entered onto the end of life care register. There was identification of locality wide training needs via the setup of OneResponse which began to be addressed e.g. development of Palliative Care Foundation Course and planning for Verification of ExpectedDeath training across the locality. This will be reviewed and developed in partnership with other providers during 2015/16.

2.4 Priorities for Improvement

Priority 1.

Embedding the dedicated Single Point of Access(OneResponse Support, Assessment and Advice Service)

There is recognition nationally of the benefits of a single point of contact /access for end of life care patients in enabling co-ordinated and timely advice and support for patients, families and professionals.

Often patients, carers, families and other professionals don’t know who to contact to access the right information, support, care and/or intervention at the right time. There is often a range of information and contact numbers left in the home and in fact too much information can be as confusing and isolating as none. Patients in palliative and end of life care situations identify a lack of one contact point as a reason they did not know who to call and therefore called an ambulance and ended up in hospital. This is true for people at all stages of their disease journey from treatment to end of life care.

Coordinating a person’s end of life care can help to reduce unnecessary or unwanted treatments, visits and emergency admissions. Sharing information with key colleagues across both health and social care will help ensure that needs are met and preferences and wishes are respected, enabling more people to die in their preferred place. The concept of the service relies heavily on the ability to apply a collaborative approach across services in South West Essex and will play a key role in supporting existing core services across a range of specialist disciplines.

An integrated model developed in partnership between St Luke’s Hospice and South West Essex Community Services (NELFT), the service will aim to support patient choice, avoid inappropriate hospital admissions and enhance quality of care.

We aim to achieve this by:

  • Working closely with acute services, providing a single contact number/ coordinated reference point for patients, families and professionals.
  • Sign posting or supporting access to palliative and end of life care services as well as other supportive and therapeutic services throughout the disease trajectory.
  • Coordinating services across a range of providers across health, social and voluntary services. The provision of support and advice will include carers, other family members and health and social care professionals
  • Establishing a process to support more patients to be cared for and to die in their place of choice and reduce inappropriate hospital admissions whilst improving the quality of care that patients and families receive, thus impacting on care, place of care and death and bereavement outcomes
  • Providing a 24/7 telephone triage/support line with specialist expert advice available 24/7
  • Offering a rapid response service and access to 24/7 holistic face to face assessment to manage changing needs
  • Providing a rapid assessment and discharge service to facilitate appropriate, safe but timely discharge whether this is a routine, terminal or fast track discharge

The Hospice will now embed a fully comprehensive model during 2015/16, evaluating outputs and outcomes in collaboration with all stakeholders, but particularly the CCG’s, Macmillan Cancer Support and service users.

Priority 2.

Fast Track Care

The CCG has commissioned the Hospice to further develop an ‘alternative’ to Fast Track.

A pilot scheme was tested on a small scale between November 2014 and March 2015 and demonstrated:

  • Improved response times
  • Improved quality experience for patients, carers and families
  • Increased ability to delivery person-centred, flexible care/care packages
  • Increased delivery of care within national fast track criteria
  • Development of a more robust but cost effective service model to develop in 2015/16

During 2015/16 the Hospice will further develop a partnership based model to deliver Fast Track Care for people who are rapidly deteriorating and approaching end of life and wish to be cared for in their own home – wherever that may be. The service offered will draw on the core elements of excellence in palliative and end of life care, supported by specialist input and expertise, driven by the need to undertake continuing assessment and review in order to address diverse, individual and rapidly changing specific needs while monitoring the range of care and care providers and that they are deployed according to those specific care needs and outcomes.

This is an innovative and exciting development which will only be successful to its fullest extent by working in an integrated way with Hospice@Home and OneResponse, but which has the potential to transform palliative and end of life care across South West Essex and impact significantly on the wider health care system.

In developing this initiative we will:

  • Work on the model in year one in order to reach full capacity and test the suggested service paradigm as entirely as possible.

Priority 3

Accommodation

On 11th June 2015 the Thurrock Planning Committee gave in principle approval to build a new Hospice on the Malgraves Farm Site in Thurrock, which would be enabled by a housing development.

Whilst the planning consent may ultimately be subject to public enquiry this currently represents a positive step in improving the Hospice’s resources and facilities for future patient care and end of life care delivery.

The new site will afford additional in-patient beds, counselling and complementary therapy facilities plus some supporting administrative space allowing for consolidation of the existing estate.

If subsequently guaranteed, the development would be a substantial opportunity to support future developments and service planning, and thereby enables a review of service distribution across the two sites to maximise service and resource efficiency.