Quality Account 2014/15
Contents
Introduction
Acknowledgements
Who we are and what we do
The John Taylor Experience
Community Interest
Part 1a The Owners’ Statement
Part 1b The Chief Executive/Board Statement
Part 2 Quality Improvement
Our People
Defining Qualities
External Scrutiny
Visits by our Commissioners, Local Area NHS Team
Community Interest and NHS Policy
Patient Opinion
Compassion
Commitment
Courage
Communication
Competency (see also Our People)
Safeguarding in the PublicInterest
Serious Incidents
Examples of how we have used Data and Analysis to Improve Patient Care
Pressure Ulcers
Lessons Learnt and Actions Taken
Further Actions Suggested by Staff
Slips, Trips and Falls
Preventative Actions taken
Our ‘People-based’ Systems for Ensuring Patient Safety
VTEs
UTIs
Medication Errors
Never Events
Our Never Events policy
Patient and Staff Experience
Friends and Family Test
Patient stories
Patient Opinion
Direct feedback
Complaints
Patient Reported Outcome Measures
Staff Survey results/feedback
Culture, being open, leadership and escalation
Equality and Diversity
Duty of Candour
Other Issues
Political astuteness of local and national priority focus
What we will/are doing to prepare and contain Ebola.
What we are doing to focus on sepsis prevention and management
Part 3 Our Priorities for the Next Year
Patient Experience
Clinical Effectiveness
Part 4 The Quality of our Services - Data
Other Quality Indicators
Cross Infection Auditors
Audited Account and Companies House
CCG Quality Review Group
Revalidation of Doctors
Environmental Health – Food standards – 5 star rating
External Health and Safety consultant once a year conducting an environmental audit.
Part 5 Statements
Mandatory and Legal Statements
Statement of Directors’ Responsibilities
Healthwatch
Appendices
Appendix 1: The Duties and Authority of John Taylor Hospice Membership Council
Appendix 2 Commissioning for Quality and Innovation for 2015 to 2016
CQUIN 1: Every Moment Matters – Patient and family Access to Wi-Fi
CQUIN 2: Macmillan Values Based Standard
Appendix 3 - Our Understanding of Accountability – the company handbook
Appendix 4 John Taylor Integrated Approach to Safeguarding
Essential Definitions in Law
Safeguarding in the Public Interest
Safeguarding and Whistle Blowing
Safeguarding in the Public Interest – Gifts and Hospitality
Safeguarding in the Public Interest – Identification and Security
Glossary
Community Interested Company
CQUIN
Delayed Transfers of Care
Duty of Candour
Key Lines of Enquiry (KLOEs)
Performance Indicators
Serious Incidents
The ‘6 Cs’
‘Never Events’
PLACE audits
Patient Reported Outcome Measures
RAG Rating or Red Amber Green
Re-admission within 28 Days
TUPE
Urinary Tract Infection
Venous Thromboembolism
Introduction
We are pleased to publish the first Quality Account for John Taylor Hospice Community Interest Company to report on the quality of the care we provide and to show the improvements in the services we provide to our patients and local community.
We would like to point out that in this account we have included subjects that are wider than the standard headings required of NHS organisations because, although we do deliver services on behalf of the Birmingham Cross City NHS Clinical Commissioning Group, we also work with other organisations, regulators, funders and community groups in our capacity as a community interest company.
As a CIC there are some subjects that NHS organisations are required to report in their Quality Accounts such as delayed transfers of care and readmissions that don’t apply to what we do, therefore, we have omitted them.
We believe this Quality Account gives you an ‘easy to understand’ description of the quality in a community interest company commissioned to deliver care on behalf of the NHS and providing care direct to the public, funded by taxpayers and direct investment by local people and grant-giving bodies and trusts. It is an affirmation of the purpose of our company and explains why we continually work to make ‘every moment matter’ in terms of the experience of people who come to us for care, work and volunteer and in compliance with national standards for patient safety and corporate governance.
Acknowledgements
This is our first Quality Account and we would like to thank all of the care staff, managers, Membership Council and our stakeholders in the NHS Clinical Commissioning Group and the local Healthwatch group for their parts in writing this.
Who we are and what we do
Founded in 1910 to assure dignity in death regardless of wealth, John Taylor Hospice is the oldest non-denominational hospice in the UK. Our foundation was based on reciprocity and the needs of local people. In 1948 our founders gifted us to the NHS and, with the passage of the Health and Social Care Act 2012, the employees at John Taylor Hospice became the owners of the hospice. John Taylor returned to its roots, becoming a social enterprise or community interest company limited by guarantee.
This means the company income can only be used for the purpose of the company – to reduce the personal and social cost of illness and death – there are no shareholders and no dividends are paid. Since 2011 the NHS has contracted directly with the CIC for care. The first three years, under the terms of the Health and Social Care Act, were a ‘spin-out’ contract. In that time the new CIC doubled the number of patient contacts annually, from 5,000 in 2011 to 10,000 in 2014. We work with adults across the spectrum of illness that foreshortens life.
The care that we provide is funded by tax payers (through our NHS contract) and directly with investment or donation from individuals, companies and community groups.
We deliver supportive care, end of life care, palliative care and specialist palliative care, providing a seamless journey with care that flexes with the needs of the patient. The NHS is a commissioner of this care and 95% of what we do in people’s own homes.
The John Taylor Experience
Care from John Taylor for most people starts with our front of house team. They are the first people that people who want to use our service, want to support what we do or want to make a referral will speak to. The front of house team is skilled in ensuring callers on the phone and at the hospice are directed to the right person. They will take confidential messages and let people know who will phone them back and when.
Our website has confidential online referral.
We hold an inter-disciplinary daily triage meeting to review all new referrals, admissions that may have happened overnight and, on a red amber green rating system, a review of people whose needs are fluctuating or for other reasons may need a change in their care.
Social Media works for people choosing John Taylor.
John Taylor means complete care - what you need, when you need it, where you need itup to 24 hours a day, seven days a week, in your home or at the hospice – your home from home. We are there all the way understanding what each person needs so that the decisions that are made are made on each person’sterms. This includes, friends, family, significant people and pets.
We use the evidence-based Macmillan Values Based Standard Framework consistently across everything that we do. In 2015, together with our NHS commissioners, we have put these standards together in the form of a CQUIN or quality measure.
We have a comprehensive annual audit programme that checks that what we do matches the standards set. Family comes first, whatever the make-up and size of your family, every moment really does matter. As well as our audit checks, we have a subcommittee of our company Board for Assurance, Regulation and Audit (ARAC). The committee has two working groups, our Clinical Governance Committee and Workplace Safety Committee.
We are externally inspected and externally regulated. This means that people can see online how we are doing. Visit the Care Quality Commission, Patient Lead Assessments of the Clinical Environment (PLACE) and Birmingham City Council Environmental Health inspectors.
We are also regulated by Social Enterprise UK. We are also a member of the Social Enterprise Mark and meet the Gold Mark standard, one of only three social enterprises to have achieved this.
All of our staff are professionally or vocationally qualified and everyone receives supervision from an appropriately qualified supervisor. We use a specially designed computer database to ensure all of our staff meet the annual training standards for their role. Continuity matters too, we use an electronic system to schedule when our staff work across every 24 hour day 365 days a year. This means that we can tell you who will be working with you and you can get to know a smaller team of our staff - building trusting relationships is what makes ‘every moment matter’ work in practice.
The first person most people meet at home is one of our community nurse specialists (CNS). A CNS is a qualified physical health nurse who has at least ten years’ experience post-qualification training and additional training in one or more specialties including palliative care, prescribing, tissue viability, respiratory care, emergency care, complementary therapies and UKCP accreditation.
Meeting a CNS means we will match your needs with other members of John Taylor’s inter-disciplinary team of occupational therapists, physiotherapists, clinical pharmacists, dietetics, social work and family care and spiritual care. Our palliative care assistants can support all of your personal care needs and, both at the hospice and at home, qualified nurses working closely with palliative care assistants will ensure that you are safe and supported on your terms. Meeting a CNS will also enable you to choose from a range of daytime support and short breaks.
Community Interest
As a Community Interest Company we are regulated to evidence our social impact. The Royal Bank of Scotland supports the nationally accepted measure of social impact called the RBS100. The maximum score for social impact on the RBS100 is 10/10. John Taylor Hospice became a CIC in 2011 and since 2013 we have met the 10 standard for social impact. We receive that score because
- We are members of the Health and Wellbeing Partnership Board locality group
- We have developed early intervention called ‘Why Wait?’
- Volunteers can become apprentices and we recruit young people as apprentices who go on to full-time employment after 12 months with us
- We provide real paid experience for graduate and undergraduate interns, some of whom choose to volunteer
- We have a vibrant corporate social responsibility programme, teams of volunteers from local companies and national companies with a local base help us keep our hospice and gardens in top condition all year round
- Local people make a direct financial contribution, matching investment from grants by undertaking challenges, team events and marathons, raising money which is then invested in what we do
- We are a Travelwise and Bike North Birmingham partner - this together with our SE Gold Mark, evidences how we trade sustainably for people and the planet, from local procurement, cycling to work, growing vegetables and planting and maintaining wildlife habitats
- In 2013/14 we were awarded RBS100 Trailblazer status for social impact. In 2014/5 we were awarded the RBS100 award for innovativestorytelling and the regional Social Enterprise West Midlands award for ‘innovation beyond expectation’.
Part 1aThe Owners’ Statement
The owners of John Taylor Hospice are the people who work in the company. Since 2011 staff who are owners, elected by their peers form the Membership Council – the ultimate authority on the governance of the company. Ownership in public sector services is a relatively new concept in healthcare. Whilst mutuality was the basis on which we were founded in 1910, the journey to ownership has been a more recent one, in which we are entering our fifth year. The Articles of Association of our company set out twelve specific duties for all Membership Councillors - we have includes these accountabilities and a broader description of ownership at Appendix 1. Four of these duties are relevant to the quality account:
- Maintain an up-to-date understanding of the priorities and aspirations of the company.
- Hold the Board to account for operating with an up-to-date Company Plan.
- Uphold the implementation of the Company Plan, company handbook, policies and priorities.
- Participate in the governance of the company either and/or:
As a member of the Membership Council
As a member of the audit committee
As a member of any sub committees, panels or fora from time to time established
In offering a contribution to the appointment of staff.
Part 1b The Chief Executive/Board Statement
The people who work in John Taylor Hospice own John Taylor Hospice. Our core values are the same as NHS England: “High quality care for all, for now and for future generations.” As a community interest company we sit at the fulcrum of change in how that care is delivered. Care is funded by the tax payer (our contract with NHS commissioners) and directly by the public and grant-giving bodies. It means that we deliver care the NHS wants and needs to buy and we innovate in attracting specific sums of money to provide additional services that reduce the demand for other NHS-funded care. It means that we can deliver both health and social care free at the point of delivery. Ownership means:
- Every moment matters. In practice this means “don’t say no say how?” and everything we do is measured against the Macmillan Values Based Standard Framework and the standards the regulators set.
- We are open to scrutiny. We are externally inspected and regulated and we encourage reciprocal partnerships – the culture of our company has an annual temperature check by Birmingham University post-graduate students studying organisational structures in public and private settings. Our staff survey is given to every member of staff and was co-designed by our owners, the Board and Membership Council.
- We are ‘more than a hospice’. Since 2011 we have worked closely with locality commissioners to describe and measure what we do. We are proud to have been alongside the people of Birmingham for four generations and we are proud of our shared history with the NHS.
- Our company contract and company handbook are designed and developed together by our owners, the Board and Membership Council. We are a family-friendly company, with flexible contracted hours similar to those available to staff working in the NHS. We invest in our staff through deferred income with both a defined contribution pension scheme and an open directions body order for the NHS pension scheme. We remunerate staff at a flat rate for their flexibility, in order to provide services at home and in the hospice up to 24/7, seven days a week, 365 days a year.
- A financial liability of £1 and a responsibility to elect six peers to form the Membership Council (the governing body of the company) and attendance at the AGM. Our governance structure is our fundamental contract of accountability to our owners, patients, families and the public. We are a company limited by guarantee, this means that the sole purpose of the company is community benefit. We describe that benefit in the following terms: to reduce the personal and social cost of illness and death, just a little every day. We measure that benefit with evidence-based measures and the decisions we make about what we do are based upon hard data and soft intelligence. Independence from the NHS and ownership means we are a commercial company with a social conscience.
This Quality Account comes as we enter our fourth year of independence. It is both a statement of progress and a statement of aspiration. The last four years have required root and branch change to regain our independence and we expect, for different reasons, the next four years to be as demanding. The Quality Account is our commitment to measure this change by the experience of the people who come to us for help, our staff and those members of the public who give directly in cash and in kind using data, hard and soft intelligence using clinical, experiential and commercial metrics.
Part 2 Quality Improvement
Our People
The majority of staff deliver direct care. The company set a series of milestones to deliver an electronic rostering system, recruitment of a bank workforce equivalent to 20% additional capacity, dedicated investment in training, ‘live audits’ of practice, a targeted consistent approach to attendance and a clinical governance committee led and chaired by clinicians with the support of managers reporting to an Audit, Regulation and Assurance Committee chaired by non-executive director(s) directly accountable to the Board.
The management structure has been streamlined with two company-wide consultations, reducing the overall expenditure on management posts from when the hospice was part of the NHS by £120,000 recurrently over three years. This saving has been reinvested in clinical posts helping to deliver the growth in clinical activity from 5,000 patient contacts in 2011 to 10,000 contacts in 2014 at no extra cost to the NHS. The e-rostering system has saved expenditure on staffing the In-Patient Unit 24/7, 365 days a year by £30,000 a year recurrently. This saving is repaying dedicated Cabinet Office investment into the ICT infrastructure at the company. The staffing ratios on our In-Patient Unit are in excess of the RCN guidelines for adult medical wards. The company does not use external agency staff routinely and by measuring attendance at work as a quality standard linked to continuity of care, rather than measuring sickness absence, there has been a gradual and sustained improvement in attendance.