Quality Report 2016/2017

Sarah, Duchess of York, is presented with a gift fromsix year old Cara Davies on her visit to Kirkwood.

Sarah, Duchess of York, visits Gary Walker on the In-Patient Unit during her visit to Kirkwood.

Introduction

The Impact of Kirkwood Hospice

Looking Back at 2016/17

Priority 1: Patient Safety

Priority 2: Patient Experience - Developing an enabling approach to palliative care

Priority 3: Hospice Enabled Dementia Care

Next Steps

Quality Overview

Contents

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Financial Instruments

The Hospice’s principal financial instruments comprise bank balances, an investment portfolio, trade creditors and trade debtors. The main purpose of these instruments is to raise funds for the operations of the Hospice and to finance the Hospice’s Services.

Due to the nature of the financial instruments used by the Hospice, there is no exposure to price risk other than that which relates to the investment portfolio. To manage this risk, the Finance and Resources Committee meet at six monthly intervals with the investment managers to review performance in the light of the investment management policy. The Hospice’s approach to managing other risks applicable to the financial instruments concerned is shown below.

In respect of bank balances,

we have taken all the steps • that we ought to have taken as directors in order to make ourselves aware of any relevant audit information and to establish that the company’s auditors are aware of that information.

In approving the Trustees’ Annual Report, we also approve the Strategic Report included therein, in our capacity as company directors.

On behalf of the board

Mr J R SpainTrustee

8th September 2017

the liquidity risk is managed by maintaining credit balances. The Hospice makes use of money market facilities when funds are available.

Trade debtors are managed by the regular monitoring of amounts outstanding for both time and credit limits.

Trade creditors liquidity risk is managed by ensuring sufficient funds are available to meet amounts falling due.

Disclosure of information to the auditors

We, the Trustees, being directors of the company, who held office at the date of approval of these financial statements as set out above each confirm, so far as we are aware, that:

there is no relevant audit • information of which the company’s auditors are unaware; and

Walkers set off on Kirkwood’s annual Midnight Memory Walk, which raises

funds for patient care.

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The aim of this report is to inform our service users and stakeholders of the progress we have been making in clinical services to ensure continued safety of our patients and that care provided is of a consistently high standard and quality.

This report is a more detailed review of just three quality priorities that we identified in 2016/17. The report also outlines what we will be focussing on in the future and has been aligned to the NHS Quality Account.

This will be the last report set out in this format. Next year (2017/18) we will be refreshing our approach to reporting and communicating the quality of care and services we deliver to our patients, families and carers. This will include more information about our successes and achievements rather than just three very specific priorities that do not lend themselves to demonstrating continuous quality improvement, service development and clinical professional development across all clinical services.

Introduction

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The Impact of Kirkwood Hospice in 2016/17A quick snapshot of how Kirkwood helped to support patients and families in Kirklees over the past year.

People admitted to our In-Patient Unit who we were able to discharge

94% Service Users who rated our care as Outstanding or Excellent

2,979 face to face appointments were made by our Community Specialist Palliative Care Team

Total number of Out of Hours

Calls received

908

The number of people supported in pre or post-bereavement through facilitated group work

913

327Total number

of admissions to Kirkwood’s

In-Patient Unit

1,169 patients supported in their own homes by our Community Specalist Palliative Care Team

106 new referrals to our Support & Therapy Department

27%

1,534individual Counselling sessions offered by our

Family Care Team

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The following three Quality Priorities were developed for 2016/17 based on; feedback obtained over 2015/16, informal feedback, complaints, clinical incidents and clinical governance issues that identified a risk or a trend. All three priorities are aligned to

Kirkwood Hospice’s Strategic Plan. Our Business Plan is currently being refreshed and will be underpinned by the Clinical Services Strategy, also in development. Priorities for both 2016/17 and 2017/18 form part of the Clinical Service Strategy.

Looking Back at 2016/17

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Patient safety has always been a priority for Kirkwood Hospice and is integral to the care our patients receive. Ensuring that the reporting and management of patient safety incidents remains fit for purpose and meets the needs of patients is essential. Drawing on key learning from Kirkwood’s Adverse Incident database, which has now been in use for two years, incident reporting and management procedures were reviewed for three key safety areas; falls, pressure ulcers and drug errors. Patient outcome measures continue to indicate that care requirements are becoming more complex and that patients’ needs are increasing.

It was important to review and audit existing robust procedures in order to identify gaps or areas for improvement.

Our key objectives under this priority area were:

To review safety data and establish our own • benchmarking figures as well as continuing to compare against Hospice UK Safety Metrics (a national benchmarking project in collaboration with other hospices which have the same number of beds)Audit and review of our reporting • documentation (e.g. Incident Forms)Audit and review of nursing documentation • (e.g. Risk Assessments, Care Plans etc.)Establishment of Safety Learning Forums• Develop processes to capture Learning • Forms, which evidence actions and learning points identified via the Learning ForumsCase reviews and in depth analysis of • patients who have had multiple falls

Achievements

Safety data has now been reviewed and

our own benchmarking figures have been established, drawing upon information from the Clinical Dashboard.

A Falls working party has been established to implement best practice, with education around falls management now included in the Mandatory Manual Handling training. Grant funding has allowed more investment in falls alarms. The falls work is being supported by the re-auditing of falls reporting forms and falls documentation to ensure compliance with NICE Falls Guidance. A root cause analysis is always performed for patients who have fallen and further analysis and audit has been undertaken to review the previous six months for multiple falls. Patient notes continue to be reviewed for patients who have had more than one fall.

Hospice UK Benchmarking continues to be under review nationally as to effectiveness and value. We also take part in the Hospice UK led clinical benchmarking Community Zoom meetings - which are facilitated virtual meetings which inform future direction and development.

Reporting forms and documentation have been reviewed and it is recognised that this will need to be an ongoing process. The adverse incident database has been cleansed.

Nursing documentation has also been audited and reviewed, including pressure ulcer documentation which has been reviewed and new documents implemented. This will be audited six months after implementation. A near miss drug error form has also been developed and will be trialled.

Priority 1: Patient Safety

Looking Back at 2016/17

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Establishment of learning forums

Learning Forums have been established and are regularly held and reported on in quarterly Quality and Safety reports. Purple practice notices have been implemented to identify good and outstanding practice and changes to practice. The Adverse Incident database has also been developed.

It is clear that the learning forums have been a valuable way of developing supportive actions to drive change and improvement. This also links with the development of the adverse incident database.

Wound Care audit

A Wound Care audit, initially completed in December 2016, was repeated in May 2017. The aim of the audit was to re-evaluate the use of the new wound documentation. The first audit highlighted the need for more guidance in correct completion of the documentation and amendments to the documentation which would aid in more accurate completion. The second audit aimed to establish whether the additional education and changes to the format had improved and achieved accurate documentation.

What this has meant in practice is:

Changes to wound care documentation to • include more thorough initial assessment of pressure areas, and clearer means of evaluating a wound on the wound care plans. Documents are now clearer to use following minor changes to wording and layout, plus changes to diagrams of head/

bodies/feet etc. Wound care documentation now includes a quality of life section, which has been introduced to consider a holistic approachIntroduction of ‘potential for pressure ulcers • care plan’ with clear indication to discuss the situation and plan of care with patients and carersA separate ‘wound care evaluation and • daily skin checks’ sheet to aid continuity of documentationAn update of the pressure ulcer policy • A pressure ulcer prevention leaflet • for patients and carers is currently in development, alongside a new hospice formulary and info fileThe changes to practice and the roll out of • new documentation have been supported by roadshows and teaching slotsThe focus on patient safety has ensured • increased awareness and enabled learning to be put into practice, for the benefit of many patients

Looking Back at 2016/17

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An enabling approach to palliative care can be defined as ‘integrating enablement, self-management and self-care into the holistic model of palliative care.’ (Taylor Dr R. 2015, Rehabilitative Palliative Care: Enabling people to live fully until they die). This is a multidisciplinary approach in which all members of the clinical team work collaboratively with the patient, their relatives and carers to support them to achieve their personal goals and priorities.

Through recognising the key challenges we face as a hospice, including increased frailty, the needs of an ageing population, living with and dying from chronic illnesses and multiple comorbidities (Taylor Dr R. 2015, Rehabilitative Palliative Care: Enabling people to live fully until they die), it is clear that an enabling approach to care will produce a more supportive experience for patients, their relatives and carers.

Our key objectives for this priority area were:

Including person-centred goal setting as • part of the assessment process rather than focusing on problems and symptomsEducating all members of the clinical • teams in goal setting and the enablement approach to careDeveloping a core team of Clinical • Enablement Volunteers to support patients and clinical staffThe development and implementation of • supported self-management, building on the success of current self-management groups such as Breathe Better (a group for people with life-limiting non-cancer lung conditions) and Braveheart (a group for people with life-limiting cardiac conditions)

Educating all members of the clinical teams in goal setting and the enablement approach to care

A hospice-wide education program has been rolled out over the past year, capturing not only clinical teams, but also non-clinical departments within the Hospice. The rehabilitative approach to care involves a cultural shift in care delivery and it was felt that the awareness of these change needed to be hospice wide, and not just limited to clinical teams.

A basic education session was rolled out to all non-clinical departments and involved Reception, Fundraising, Support Services, Trustees, Administration and Finance, Patient Representatives, KirkwoodAmbassadors and Volunteer teams, plus a session was videoed and circulated to shops. Feedback was very positive and teams actively engaged in the sessions and gained an insight into the reasons why personalised goal-setting enriches and enhanced patient’s quality of life.

Clinical teams, including volunteers within Support and Therapy, participated in a series of time out sessions focusing on goal-setting and finding out what really mattered to patients. Services have been adapted and created in order to accommodate this shift in service delivery.

On the In-Patient Unit, education sessions took place with a hugely positive response from the nursing teams. Attendance and enthusiasm was overwhelming with many valuable suggestions and ways that we can move forward with the concept of enablement. In total 100% of our regular auxiliaries and almost 75% of

Priority 2: Patient Experience - Developing an enabling approach to palliative care

Looking Back at 2016/17

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our qualified nursing teams have attended the training sessions and are keen to embed enablement into daily clinical practice as they can see the additional levels of quality of life it can give our patients.

By including person centred goal-setting as part of the assessment process, our OT and Physiotherapist are proactively identifying goals with patients on IPU, with goals further discussed in weekly MDT meetings. We recognise as a hospice that both goal-setting and the wider enablement model of care, are integral to the delivery of our clinical services strategy.

Developing a core team of clinical enablement volunteers to support patients and clinical staff

Work is underway with our Volunteer Services Manager, around the scope and role of the team of volunteers that would fall under the remit of Befrienders. The volunteer Befriending role is a new development for the hospice, which will play a vital part in the development of enablement model of care, both within the hospice and with patients at home. It will allow clinical teams to identify goals with patients and ensure these goals then follow the patients from Hospice to home in a seamless manner, ensuring that opportunities are not missed. Patients can work towards achieving meaningful and significant objectives in their final days, weeks and months of life.

As clinical teams are becoming more skilled at identifying goals with patients, the role of the enabling volunteers is becoming clearer and it will be an exciting and rewarding opportunity for many volunteers both new and already

known to Kirkwood.The development and implementation of supported self-management, building on the success of current self-management groups such as Breathe Better (a group for people with life-limiting non-cancer lung conditions) and Braveheart (a group for people with life-limiting cardiac conditions)

With the Enablement model central to developments and changes within Support and Therapy, a more targeted and structured approach to patient care is evolving. Enabling through self-management programs allows patients to develop mastery over their symptoms and allows them a better quality of life by being more in control of their symptoms.

The multi-disciplinary team working within Support and Therapy has worked to highlight gaps in service due to the changing nature of hospice day therapy patients. It was felt that self-management groups would help tackle and address the changing nature of conditions we are seeing within Support and Therapy.

It was also evident that there needed to be a shift away from traditional care delivery models of Day Therapy. The disease trajectory of non-cancer conditions demands a different way of delivering timely and appropriate hospice day therapy services.

These factors lead to the creation of two new sessional groups for patients and carers living with life limiting neurological conditions. They are self-management groups and have goal setting and patient centred care underpinning all sessions.

GOAL, a new 12 week neurological self-

Looking Back at 2016/17

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management group has been created to address the needs of patients and carers living with life limiting neurological conditions who are mobile and potentially still working. The second sessional group is for neurological patients and carers living with a life limiting condition that is significantly compromising their function. Although the first cohort of the groups is still in progress, the feedback from staff and patients has been overwhelmingly positive.

GOAL currently has 6 patients and 4 carers attending weekly with a 90% attendance. The afternoon session has 4 patients and 3 carers attending with an attendance of around 75%.

A goal focused approach is taken in both groups and already patients can see a difference in themselves, their perception of their condition and their relationships with carers and family. Anecdotal feedback and staff observation has highlighted the changes patients and carers are noticing.

The move towards self-management provides empowerment and fundamentally underpins

the concept of the enabled patients to achievea better quality of life. It extends the philosophy of palliative rehabilitation beyond cancer patients and is beginning to reach groups that traditionally haven’t accessed hospice care.

Including person-centred goal setting as part of the assessment process, rather than focusing on problems and symptoms, marks a new approach and a change in culture.

The focus within Support and Therapy is very much moving towards goal setting with all patients. Clinical meetings and discussions are having a more enabling and rehabilitative focus in order for patient’s goals and wishes to be accounted for. Clinical documentation has been adapted to allow staff to capture rehabilitation goals and ensure that all team members are working towards the patient’s goals.

Work is now underway to scale up this shift of goal setting culture on to the In-Patient Unit. Successful goal setting relies on collaborative action planning between the patient and the all multi-disciplinary team members.

Looking Back at 2016/17

Jean Lowe GOAL changed my life to be perfectly honest. Before I came on this course I thought that I was coping with MS. I realised a few weeks into it that I wasn’t really coping. Before I came here, I thought ‘I have MS’, but I came away thinking ‘no actually, I’m Jean’. I was Jean before and I am Jean again.

I wanted to be able to get more excercise.After a few weeks, we went down to the local leisure centre and found it to be right. I am still going swimming now.

Karen Booth I didn’t want to come [to the Hospice] at all. I felt small, I just wanted to disappear. A couple of weeks in, after talking to Jean and the others, I felt lifted. It changes your life, it really does. I feel different now after GOAL. I wouldn’t have done half of the stuff I’m doing now if it wasn’t for that group.

It’s given us the boost to actually go out and live.

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Getting on and Living - What People Are Saying

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The third priority for the Hospice was developing and implementing Hospice Enabled Dementia Care. Dementia is considered a life-limiting illness and one that will often exist alongside other chronic conditions. The number of people who die with dementia is high and likely to increase in the future. Hospices can make a significant contribution in providing care and support for people affected by dementia. Kirkwood Hospice has always been, and continues to be, forward-thinking and innovative. We acknowledge the need to respond to the changing needs of our local population which is why becoming a Hospice enabled to provide care and support for people with a diagnosis of dementia at the end of their lives was chosen as a priority for 2015/16.

The key identified objectives were:

A Hospice wide commitment to engage with • the agenda of dementia careTo establish new partnerships • Creativity in the provision of care and • services which meet the specific needs of people with dementiaAn evidence based approach to care and the • care environmentInvestment in training and education of • employees and volunteers

Implementation of Hospice Enabled Dementia Care

Establishing new partnerships to support this initiative was one of the targets for 2015-16. Partnership with Dementia UK, Kirklees Council and Kirkwood Hospice saw the introduction of the first End of Life Care Admiral Nurse based within a UK hospice. This is a fixed term contract for two years initially. This Admiral

Nurse is based within the Specialist Community Palliative Care Team and has now been in post for one year. The partnership of specialists from the areas of palliative and dementia care will support those in Kirklees living and dying with, and from, dementia to access the most appropriate services for them as the disease progresses.

There is evidence to suggest advance care planning (ACP) at an earlier point in the dementia disease trajectory supports people to die well in the place of their choosing. The Kirkwood Admiral Nurse has a role in supporting ACP and helping those locally living and dying with dementia to have difficult conversations and document their wishes and preferences.

Since coming into post, the Admiral Nurse has developed partnerships and relationships with a number of external organisations. Use of the Hospice and its services by people with dementia and their carers has grown since the introduction of this service. In partnership with Kirklees’s existing Admiral Nurse team, Support and Therapy will be hosting “Positive Steps”, a four week dementia carer education programme in September 2017. Carers have found this difficult to access in the past due to not having any care or support available for their loved ones whilst they attend. For the first time in Kirklees, both carer and the person with dementia will attend together. Whilst carers attend the programme the Admiral Nurse, Support and Therapy staff and volunteers will engage people with dementia. It is hoped this initiative will continue to evolve and grow and be hosted by Kirkwood Hospice for the foreseeable future.

Priority 3: Hospice Enabled Dementia Care

Looking Back at 2016/17

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The Admiral Nurse has supported a review of dementia focused training for staff and volunteers at Kirkwood. An electronic mandatory Dementia Awareness module is now included in these requirements. Dementia awareness sessions, via the Alzheimer’s Society’s Dementia Friends initiative, are also available on a monthly basis. The Admiral Nurse is Kirkwood’s Dementia Friends Champion and delivers these. There is also one day training on promoting excellence in dementia care available four times throughout the year. The Dementia Friends and one day training sessions are also open to external organisations who have been taking advantage of this. Dementia Champions have been developed across the Hospice, including at executive and board level.

Other activities include:

Mandatory dementia training reviewed and • now ongoingDementia training developed and offered to • all Hospice staff and external organisationsHospice environment reviewed from • an evidenced-based dementia friendly perspectiveInclusion and consideration of dementia in • all departmental strategic reviews General well-being support strategy for • staff and volunteers developed, which includes an awareness of dementia for both development and caring responsibilities. Increased numbers of people with dementia • and carers now accessing Communty Specialist Palliative Care Team and Kirkwood Hospice in generalConsideration of people with dementia and • their carers as part of the development of the befriending scheme.

During year two, the Admiral Nurse activity will focus on the following:

Continued development of relationships and • joint working with external organisations Develop hospice dementia focused training • for 2018 (including delirium, End of Life Care)Review of budgets for higher level study and • external course attendance Update Kirkwood Hospice Dementia • Strategy and set new objectivesContinued review of Kirkwood as a dementia • friendly environment (both physical surroundings and personnel)Year 1 report Admiral Nurse service• Ongoing evaluation of Admiral Nurse service• Contribute to the development of a business • plan to explore the future direction and priorities of the dementia specialist post at Kirkwood Hospice. Scoping existing local services to identify • any barriers to accessing Kirkwood Hospice, which may include cultural beliefs, location, level of impairment and knowledge.

Relationships have been established with external partners and providers of dementia support services including:

Locala• Kirklees Council• SWYT• Third sector and voluntary organisations • University of Huddersfield •

Successes:

All of the above in a very short space of time• Completion of operational policy (which is • planned to be reviewed)

Looking Back at 2016/17

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Extending reach and awareness of Hospice • services via development of multiple relationships and joint working with external partners and organisationsA number of abstracts accepted and • presentations madeContributed to dementia and ACP national • workshopCo-authored paper published on the role of • Admiral Nurses in UK hospicesIncreased number of people with dementia • and carers accessing services at Kirkwood Hospice Increased opportunities to engage • interested staff and volunteers in dementia careRecent discussion with one of the current • stakeholders has secured £5,000 in the future towards dementia care at KWH

Looking Back at 2016/17

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The Hospice is now receiving more feedback from patients, families and carers than ever before. This feedback provides a rich source of information which can be used to inform future Quality Priorities, improve existing services and develop new services.

In 2017/18 there will be some significant developments with the implementation of a Clinical Services Strategy. This plan has been developed with consultation of all the teams working in clinical services. Before this plan is agreed by the Board of Trustees, our service users and stakeholders will have an opportunity to view the plan and add their comments and suggestions, ensuring that we strategy is a co-designed document reflective of the needs of our patients and families.

There are however three key clinical developments that will run throughout the strategy and these include:

A two year project to upgrading our current • Electronic Patient Record system.Further developing the use of patient • outcomes to inform nursing and medical care to show measurable improvements in patients symptoms, comfort and wellbeing . Integrating the Enabling Quality of Life • Model of Care throughout all clinical services

Detailed below is further information about these three key developments for 2017/18.

Clinical System Upgrade

SystmOne (S1) Palliative Medicine is the clinical IT package in use at the Hospice. It was first introduced in 2011 as part of a regional drive

to have a common system (within palliative care) that could be widely accessed and improve care, particularly for patients accessing urgent care services. Since then, our use has slowly increased and has included replacing most of the paper patient records in both the Community and Support and Therapy teams. The module currently being used will no longer be developed and will instead be replaced with a new module which has a number of additional functions, with others in the pipeline that will aid the ongoing use and development of clinical IT within the organisation. Upgrading the clinical system we use will ensure that our needs will be met for the foreseeable future.

The key benefits anticipated include:

Safety

Improved patient information sharing into • and out of the organisationInformation is always available in real time• Records are legible and auditable• Has the potential to prevent medication • errorsWill flag up when further information, key • interventions or medication administration is requiredElectronic stock control •

Efficiency

More automated transfer of information into • and out of the organisation Single system for recording information • meaning less duplication Multiple staff members can contribute to an • assessment simultaneously Improved audit efficiency•

Next Steps

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Better use of resources

Reduction in printing and paper costs• Reduced costs for storage of historical IPU • patient notes Decreased confidential waste disposal• Better use of staff time –allowing staff to • spend more time with patients and relatives thus improving patient care and safety as well as potentially releasing time for other projects and initiatives within the hospice

Kirkwood’s key targets will be:

To review and streamline our current • SystmOne use across the organisation, upgrade to Palliative Hospital and make use of the additional functions availableTo develop and implement and Electronic • Patient Record (EPR) for the In-Patient Unit (IPU)To implement Electronic Prescribing and • Medication Administration (EPMA) for the IPU when this function is released by TPP (expected in 2017)

Enabling Quality of Life (EQOL)

An enabling approach to palliative care can be defined as ‘integrating enablement, self-management and self-care into the holistic model of palliative care.’ (Taylor Dr R. 2015, Rehabilitative Palliative Care: Enabling people to live fully until they die)

Over the past year, multi-disciplinary work has been ongoing to move towards an approach in which all members of the clinical team work collaboratively with the patient, their relatives and carers to support them to achieve their personal goals and priorities.

Hospices are facing key challenges, which include; ‘adapting to the needs of an ageing population, living with and dying from chronic illnesses and multiple comorbidities, increasing frailty and disability’ (Taylor Dr R. 2015, Rehabilitative Palliative Care: Enabling people to live fully until they die). With this as the focus, the Hospice will continue to develop an enabling approach to care.

Kirkwood’s Key targets will be:

Continue to work towards a culture of self-• management and supportive enablement by further educating both staff and patients and embedding this in to daily practise The use of One Page Profile document in • clinical practise to ensure that personalised care and goal setting is central to the holistic care given by the multi-disciplinary teamAs a multi-disciplinary team, patient goals • and priorities are focussed on within the weekly team meeting with progress, achievements or setbacks fed back and actions identified for the coming weekContinue to work with the Volunteer • Coordinator as work moves forward with the enabling volunteers and the befriending service

Next Steps

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they have previously enjoyed.

When patients start to enjoy things that are really important to them, their quality of life improves because their illness and limitations become less of a barrier.

How important is it that people with a life limitingillness continue to set goals and targets for the future?

Sometimes patients feel there is no point in continuing to participate in activities, so stop doing things that they enjoy. Professionals, carers, friends and family can also be very protective, doing things for a patient or loved one that they are capable of doing themselves. This can be very disempowering for someone with a life limiting illness.

Setting goals encourages patients to reconnect with friends, family and interests. As they achieve these goals, patients begin to focus on more positive aspects of their lives and manage their illness better.

Do you have any examples that you can share?

We have helped families to create special memories together with pizza and movie nights, picnics and Easter egg

What is the EQOL project and who does it support?

The Enabling Quality of Life project was developed to help people to increase their ability to be independent and to help them to remain as active as possible, in spite of their illness.

EQOL is aimed at any of our patients whether they are living at home or as an in-patient here at Kirkwood. Some of our patients are fully independent, whilst others need assistance to move and some are unable to get out of bed at all. We assess all our patients individually and offer the support that is right for them. Simple small things can be so important, especially when people are too ill or fatigued to get out of bed. Goal setting helps us to find out what is important for a patient to achieve or do whilst they are being supported by the Kirkwood team.

How are people benefitting from this project?

We are helping people to achieve goals, be more active, better manage their symptoms and find ways to cope with their changing condition in proactive and positive ways.

As a result, we are helping to improve people’s confidence and reduce anxiety about taking part in activities that

Enabling Quality of Life for our patients

Earlier this year, the team at Kirkwood Hospice launched the EQOL project, which is helping to support people with life limiting illnesses to improve their quality of life. We caught up with physiotherapist, Lisa Wright, to find out more about what EQOL actually means and how the project is already showing positive results.

hunts in the garden, as well as small activities such as spa baths and makeovers.

We’ve also created opportunities for peopleto do some gardening and join exercise groups to encourage improvements in mobility and function. These have helped patients to feel confident about doing more activities at home and helped them to more fully participate in life.

How will Kirkwood continue to develop this project?

The enablement programme is growing all the time. Supporting people to live the best quality of life possible is one of Kirkwood’s key priorities and we are developing the EQOL project with all of our services. We are committed to making sure that people in our care are able to focus on what is important to them and supporting them to achieve their goals.

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During 2016/17 Kirkwood Hospice has provided for the NHS:

In-Patient care for 290 patients, providing 24 • hour care seven days a week and supported by a team of specialist staff - 327 admissionsSupport and Therapy Centre – Day Hospice • and Drop-In services to 350 patients and carers. This service provides patients with extra support to manage symptoms, gain confidence at home and maximise quality of lifeOut-Patient services - these include; • Consultation clinic with the Consultant in Palliative Medicine at Kirkwood Hospice, an Advance Care Planning clinic with a Hospice Doctor and a nurse led Lymphoedema follow up clinic A Community Specialist Palliative Care Team, • providing specialist advice in a person’s home or care home across Kirklees. The team has provided advice and support to 1169 people24/7 Specialist Palliative Care Telephone • Advice Line. The advice line regularly receives over 75 calls per monthFamily Care Team - Psychological Support • Services and Counselling (pre and post-bereavement) and Spiritual Care, which provided support to over 470 peopleThe Complementary Therapies team offer • a wide range of treatments. Last year it provided; 100 Complementary Therapy Assessments, 432 Aromatherapy treatments, 217 Reiki treatments and delivered group Tai Chi course to 90 individuals

Quality and Education - this department provides training and education to employees of Kirkwood Hospice, healthcare professionals working in Kirklees (such as Locala Community

Nurses, Nursing and Medical staff from Calderdale and Huddersfield Foundation Trust and the Yorkshire Ambulance Service)

An End of Life Care PG Cert has been developed in partnership with Huddersfield University . The course provides students with the opportunity to consolidate and enhance knowledge and understanding of effective palliative/end of life care. Learning is focussed towards enhancing knowledge, skills and the essential attributes required to drive high quality care for the individual with palliative care needs, whilst encompassing the care and support of families and loved ones in a variety of health and social care settings. We are committed to ensuring that palliative and end of life care education is available for all health and social care professionals, facilitating the transfer of policy into practice for the benefit of the patients who are cared for.

Hospice services are available to anyone with an active, progressive and life-limiting disease where the patient has unresolved and complex needs that cannot be met by the caring team. Details of the Hospice’s Eligibility Criteria are available at:

www.kirkwoodhospice.co.uk

Kirkwood’s services are provided by a multidisciplinary team employed by Kirkwood Hospice and meet NICE (2004) guidance:

Registered Nurses and Healthcare Assistants • (Auxiliary Nurses)Physiotherapists• Occupational Therapists• Social Workers• Complementary Therapist•

Quality Overview

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Kirkwood Hospice has supported 10 patients recruited to take part in the IMPACCT research programme.

IMPACCT (Improving Pain Management in Advanced Cancer) is a five-year programme funded by the National Institute of Health Research (NIHR) Programme Grant for Applied Research (NIHR PGfAR).

The IMPACCT Implementation Feasibility Trial aims to assess the feasibility of implementation and uptake of evidence based interventions into routine clinical practice in order to determine whether there are potential differences with respect to patient rated pain, healthcare use, patient pain knowledge and experience, quality of life and cost effectiveness.

Quality Overview - Research

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In-Patient Admissions*All figures affected by transfer of care to HRI from 31 May 2012 to 29 July 2013 2016/17 2015/16 2014/15 2012/13

In-patient admissions (started within year) 315 353 328 *284In-patient admissions (on-going) 12 10 10 *17TOTAL 327 368 338 *301

Discharges from In-Patient Unit 88 106 125 *97Admissions ending in death 231 245 203 *201Average length of stay in days 12.8 12.4 12.4 *12.4Bed occupancy 70% 74% 70% *66%Throughput per bed 19.7 22.1 20.5 *20

Support & Therapy Centre 2016/17 2015/16 2014/15 2012/13

New referrals for Day Attendance (Day Care) 106 95 131 127Repeat referrals for Day Attendance 7 1 3 3Continuing referred patients 50 45 65 24TOTAL 163 141 199 154

Available places in year 1960 2152 2856 2248Booked attendances in year 1011 1133 1951 1410Attendance rate for those booked 82% 81% 80* 78%Drop In service new attendees (patients & carers) 196 190 128 220Drop In service re-accessing attendees (patients & carers) 9 2 6 0Continuing attendees (patients & carers) 115 159 184 94TOTAL (patients & carers) 320 351 318 314

Within the reporting period, as part of the enabling model, a new approach to traditional day care services has been taken, resulting in a ‘Drop In’ model.

Community Specialist Palliative Care Team 2016/17 2015/16 2014/15 2012/13

New referrals 890 928 461 585Re-referrals 74 54 34 81Continuing patients 205 131 155 144TOTAL 1169 1113* 650 810

Quality Overview - Tables

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Community Specialist Palliative Care Team (cont,) 2016/17 2015/16 2014/15 2012/13

Community visits 2981 *2428 1391 1884Telephone contacts 12116 *9492 4455 4778

*This marked the year the Community Specialist Palliative Care Team expanded to cover North Kirklees.

OOH Advice Line Calls 2016/17 2015/16 2014/15 2012/13

Number of calls received Out of Hours 908 724

Information not available for 2014/15 and 2012/13. The above figures are for Out of Hours advice calls after 16:30 and before 8:30 Monday to Friday, as well as calls received on weekends and Bank Holidays.

Post-Bereavement Service 2016/17 2015/16 2014/15 2012/13

New service users (Post-Bereavement Only) 186 215 194 349Continuing service users (Post-Bereavement Only) 188 165 169 111Re-accessing users (Post-Bereavement Only) 0 22 9 3TOTAL 374 402 372 463

Pre and Post-Bereavement 2016/17 2015/16 2014/15 2012/13

Individual counselling sessions 1534 13711 12841 1288Client & family joint counselling 147 1592 0 0Face to face facilitated group work 913 908 764 716Telephone support over 10 minutes 70 79 88 65

1 On the revised MDS for 2014-2015 only post bereavement contact is reported on. To keep the figures in line with previous years, this figure is for pre and post-bereavement counselling with patients and relatives.

2 During the reporting period there have been changes to how we collect pre-bereavement contact; this is reflected in the increase in this figure which reflects more accurately the work undertaken by the Family Care Team with clients and families on the In-Patient Unit.

Quality Overview - Figures

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Infection rates continue to remain low in the Hospice, supported by a designated lead for Infection Control and mandatory Infection Control training. The lead Nurse for Infection Control attends Infection Prevention Link Nurse meetings at the Calderdale and Huddersfield NHS Foundation Trust, where close links have been established. She is also an active member of the Infection Prevention Society and is supported in the role by a number of Infection Control Champions.

A ‘bare below the elbow’ policy is in place across the In-Patient Unit and patients admitted who are known to have an infection are nursed in a single room.

Infection Rates

Regular Infection Prevention meetings are held internally and externally. A comprehensive programme of Infection Control audit is in place, which includes an external audit by the Kirklees Community Infection Control Team. In 2016/17 the Hospice achieved a score of 100% in the annual Kirklees Infection Prevention and Control External Audit.

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In 2016/17 there were a total of five formal complaints received regarding clinical services and nine concerns were raised. In 2016/17 Kirkwood Hospice cared for 1,439 unique patients; a 5.7% increase on the previous year. The number of complaints received amounted to 0.35% of patients who have accessed or are currently using Hospice services. Concerns totalled 0.63%.

Clinical concerns continue to be consistently captured, with all clinical concerns recorded formally and fully investigated. All complaints and concerns raised in 2016/17 were managed as per policy and within agreed timescales.

Complaints

Outcomes from complaints and concerns have included policy and procedure reviews, education and training.

No complaints were made directly to, or referred on to, the Care Quality Commission.

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Service users, carers and family members attend the first Getting On and Living course at Kirkwood Hospice.

01484 557900

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Kirkwood Hospice is an independent hospice and a Registered Charity (Number 512987).

Company Limited by Guarantee in England No. 1645888