Quality Account 2019–20 Our quality performance, initiatives and priorities

Contents

Part one: Our commitment to quality 6 1.1 Welcome to our annual Quality Account: Joint statement from Heidi and Neil 6 1.2 Our vision, mission and values 9 1.3 Our service map 10 1.4 Putting our work in context 11 1.5 Our core services and national service offer for palliative care, neurological care and bereavement support 12 1.6 Responding to Covid-19 13

Part two: Our priorities for improvement 2019–20 14 2.1 Progress against our priorities for improvement 2019–20 15 2.2 Priority 1 (and case study) 16 2.3 Priority 2 (and case study) 18 2.4 Priority 3 (and case study) 20 2.5 Priority 4 (and case study) 22 2.6 Priority 5 (and case study) 24 2.7 Our priorities for 2020–21 26 2.8 Statements of assurance 28 2.9 Indicators for quality 31

Part three: Other information 38 3.1 Linda’s story (case study) 38 3.2 Lee and Jean’s story (case study) 39 3.3 Sam and Ben’s story (case study) 40 3.4 Penny’s story (case study) 41 3.5 Kirsty’s story (case study) 42 3.6 Hannah Halliwell (case study) 43 3.7 Donna Lovie (case study) 44 3.8 Quality driven by research 45

Annexes 46 Annexe 1: Commissioner and service user feedback 46 Annexe 2: Final statement 51

4 5 Part one: Our commitment to quality Part one: Our commitment to quality

1.1 Welcome to our annual Quality Account

Joint statement from our Chief Executive and the Chairman of Trustees

Welcome to our Quality Account for 2019–20. We expanded our provision of specialist neurological at all levels within the organisation, this investment We’ll also be sharing stories from some of the Whether someone is struggling with a terminal support by developing our buildings, including in learning and development is helping staff to fulfil patients, service users and families who’ve illness, the loss of a loved one or a neurological doubling the size of our facility at Sue Ryder their potential and deliver our collective ambition to experienced our palliative, neurological and condition, Sue Ryder is there when it matters. Our Neurological Care Centre Dee View Court in Aberdeen. provide more care for more people. We’ve focused a bereavement support to help demonstrate our palliative, neurological and bereavement support We completed the construction of the brand new lot on mental health, with a new e-learning module person-centred approach to care. is delivered at our hospices and neurological care Sue Ryder Neurological Care Centre Lancashire in for all colleagues launched on World Mental Health centres, and through our services in the community, Preston, which has 40 rooms and four supported living Awareness Day and new training courses. There’s been As Chief Executive and Chair of Trustees, we are in people’s homes and online. Our doctors, nurses, apartments, and we increased our rehabilitative care new opportunities for some of our 9,000 volunteers assured through consistent monitoring and reporting therapists, counsellors and carers give people the provision at Sue Ryder Neurological Care Centre The too, including e-learning on relevant compliance areas. that, to the best of our knowledge, the information in expert care and compassion they need at the most Chantry in Ipswich. This training is very important to ensure the safety and this document is accurate. difficult time of their lives. We pride ourselves on security of the people we support in our hospices and putting our patients, service users and their families We are helping more and more people to cope neurological care centres and the response from our We would like to thank you for your interest in Sue first; taking the time to understand what’s important with bereavement through our Sue Ryder Online volunteers was fantastic. Ryder. To find out more about our work and to support to people and giving them choice and control over Bereavement Support, which incorporates our Online us further, visit www.sueryder.org. their care. Bereavement Community, Online Bereavement When it comes to our plans to enhance our technology, Counselling and bereavement information and our business intelligence reporting continues to 2019–20 was the second year of our five-year strategy, resources. In 2019-20, there were over 110,000 visitors develop, with improvements to our healthcare More Care for More People, and we continued the to our online community and we completed 156 reporting systems underway. We completed the rollout great progress we made in year one. counselling assessments, with 83% of people going on of our new neurological site management system, at to book counselling sessions. three of our neurological care centres, with the fourth Neil Goulden Heidi Travis We grew our specialist palliative care in the community centre being added later in 2020. This will provide more Chairman of Trustees Chief Executive in a number of different ways. We embedded our One of our key ambitions is to be an outstanding effective, consistent support for care planning and Sue Ryder Palliative Care Hub South Oxfordshire, provider of care. That’s why it’s important for us to maintaining patient records. We are working on virtual which includes a rapid response service and crisis ensure that this care stands up not only to the high- care developments by piloting online consultations service to prevent hospital admissions. There is also quality measures set for us nationally, but to the high from Sue Ryder Wheatfields Hospice. Feedback from a Hospice at Home team, enabling more people to standards that we set for ourselves. Five services were service users and clinicians has been positive on the receive packages of care and leave hospital when they inspected by the CQC during the year – we are very benefits of using this remote technology. wish to be cared for at home. Our Gloucestershire proud to say that four of these increased their rating community team also increased its reach across the from Good to Outstanding and one service maintained The Quality Account is our opportunity to set out our county, supported by a telephone support line offering a Good rating. approach to care quality and standards, as well as help and advice to patients seven days a week. We review our progress against last year’s objectives. expanded our community service in Cambridgeshire As well as these fantastic achievements within our and developed our Palliative Care Hub in Bedfordshire, care services, we also made progress in our plans As in 2018–19, this year’s account will focus on which delivers planned and crisis care and manages to invest in the education and development of the following: all patients on the end of life register. The service now our workforce. Through our contribution to the • Our commitment to quality takes all referrals for patients requiring an end of life Government’s Apprenticeship Levy, we are now able • Our priorities for improvement for 2019–20 package of care previously referred to the Continuing to offer structured apprenticeship opportunities to • Our progress against our priorities for improvement Healthcare (CHC) fast track service. new and existing employees through the Sue Ryder • Our priorities for improvement for 2020–21 Knowledge Academy. With qualifications available • Our indicators for quality in 2020–21

6 7 Part one: Our commitment to quality Part one: Our commitment to quality

1.2 Our vision, mission and values

At Sue Ryder, we’re passionate about giving people the quality of care they deserve.

For us to achieve this, we have a clear vision of what we want to achieve, an ambitious mission, and operate with three corporate values. Our corporate values were updated by our staff during 2019 and reflect our passion and commitment to work together and be the best we can be.

Our vision There are three new values, each incorporating three new behaviours (nine in total): We see a future where our palliative and neurological care reaches more communities; where we can 1. Supportive – listen/respect/encourage: help more people begin to cope with bereavement; We’re here for people when it matters, and that and where everyone can access the quality of care includes each other. We encourage, inspire and help they deserve. one another, and celebrate success.

2. Connected – communicate/collaborate/share: Our mission When we work together, we can achieve so much Sue Ryder supports people through the most difficult more for the people we support. We respect that times of their lives. Whether that’s a terminal illness, the everyone at Sue Ryder plays a vital part in delivering loss of a loved one or a neurological condition – we’re quality care. there when it matters. Our doctors, nurses and carers give people the compassion and expert care they need 3. Impactful – challenge/improve/deliver: to help them live the best life they possibly can. We find new and inspiring ways to positively impact the people we support – from small gestures to big breakthroughs. This proactive attitude drives us Our new values forward to achieve our ambitions and transform lives. As part of our ‘We are Sue Ryder’ culture development programme and to support our five-year strategy to provide more care to more people, we’re proud to introduce our new shared values and behaviours. These are designed to help us to work together as effectively as possible, ensuring everyone is focused on our collective ambition and how their individual contribution can help us to achieve it.

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1.3 Our service map 1.4 Putting our work in context

Personalisation is central to the way we provide our care, which is also in line with government policy direction on health and social care. Not only do we aim to constantly improve the care we provide, we make the case to government to put in place enablers to allow constant improvement in personalised care.

We’ve done this through our role in the review of the Using our expertise via our What Matters to Me training Supported living Ambitions Framework for palliative care in England. programme on human rights in end of life care, we 16. Sue Ryder Supported Living Unit, Aberdeen 16 10 Aberdeen 17. Sue Ryder Supported Living Unit, Ipswich We’ve presented evidence to the House of Commons’ worked with a range of stakeholders to develop a Angus Work and Pensions Select Committee on why the policy proposal on this issue, which we intend to take Bereavement Support Payment should be improved forward in 2020–21. Perth and Kinross 12–14 and were then invited to participate in programmes to Stirling Palliative care 1. Sue Ryder Duchess of Kent Hospice, Reading, improve support for people dealing with bereavement As the coronavirus pandemic spread to the UK, and Falir including Reading and Woingham community by the Department of Work and Pensions. We’ve our services were impacted, we worked with local services and Sue Ryder Palliative Care Hub Bershire 2. Sue Ryder Lechampton Court Hospice, Cheltenham, been involved in a group that has introduced a MPs, government and national politicians to ensure including Gloucestershire community services 3. Sue Ryder Palliative Care Hub South Oxfordshire Bereavement Charter for Scotland. Along with an we received the financial and practical support we 4. Sue Ryder St John’s Hospice, Moggerhanger, including alliance of other health charities and professional required to be able to respond effectively. Sue Ryder Palliative Care Hub Bedfordshire . Sue Ryder Thorpe Hall Hospice, Peterborough, bodies, we’ve been making the case for investment including community services in community rehabilitation including for people with We will continue to learn from this experience and Neurological care 6. Sue Ryder Wheatfields Hospice, Leeds, including 8. Sue Ryder Neurological Care Centre community services neurological conditions. share our learning so that the health and social care The Chantry, Ipswich 7. Sue Ryder Manorlands Hospice, Keighley, including system can continue to work together to provide 9. Sue Ryder Neurological Care Centre community services Cuerden Hall Keighley ongoing services whilst responding to coronavirus. 10. Sue Ryder Neurological Care Centre 7 6 Dee View Court, Aberdeen 11. Sue Ryder Neurological Care Centre 9 Leeds Stagenhoe, Hitchin Preston

Community services 12. Sue Ryder Angus Homecare, Arbroath 5 Peterborough 13. Sue Ryder Stirling and Falir Homecare, Stirling 15 14. Sue Ryder Perth and Kinross Bedford 4 Hitchin 8 17 Ipswich Homecare, Perth 11 (up until January 2020) Cheltenham 2 1. Sue Ryder Dementia South Oxfordshire Together, Suffolk 3 Reading 1

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1.5 Our core services and national service 1.6 Responding to Covid-19

offer for palliative care, neurological care and During this reporting period, Sue Ryder services Where possible staff worked from home, clinical bereavement support have cared for people with suspected or confirmed absences were supported by bank staff and staff Covid-19. As incidence increased in communities, re-deployed and suitably trained. The flow of external Specialist neurological care: 7/7 CNS service: many staff have also been affected by the disease visitors was significantly restricted to protect the Specialist neurological care centres: • Community nurse prescribers which put our services under great pressure. Despite vulnerable people in our care. For many people and • Post-acute rehabilitation • Specialist needs assessment, planning and co- this and as lockdown ensued, the critical incident staff, the restriction of visitors and the inability to • Slow stream rehabilitation ordinating care for people at home response by Sue Ryder ensured all services were fully provide face-to-face care for the whole family has been • Complex disability management prepared with key risks to the organisation led by a incredibly difficult. Staff have quickly adapted their • Support for people with cognitive impairment and Day therapy: major incident team: therapeutic approach to provide virtual support to more behavioural needs • Delivering flexible, responsive ‘packages of care’ people receiving care at home and supported people to • Non-invasive ventilation and tracheostomy care tailored to individual need • All business continuity plans revised to mitigate for: use technology to stay connected with loved ones. • Neuro-palliative care • Outpatients • Therapeutic support such as physiotherapy, • Specific clinics, ‘drop-in’ visits o Disruption of supplies (medical and non-medical) As the situation evolves, practices are being evaluated occupational therapy and psychological support • Long term conditions programmes using service user feedback to ensure the quality of • Providing social and recreational activities that • Medical outpatients with interventions o Disruption due to significant staff shortages services remains high and is responsive to need. The enhance wellbeing and quality of life governance of care quality during this period has Patient co-ordination: o Disruption due to loss of income and continued as per our usual process. Supported living: • Palliative care co-ordination increased costs • Link to neurological centres • Delivering co-ordinated and seamless access and • Link to step up/step down transition through all services and settings • Infection prevention and control practices – • Hospital and care home in-reach service guidance revised, updated and training provided Neurological community services: • Care at home Carer and family support: • Situation reporting – internal monitoring and to • Self-management and preventative programmes • Bereavement, spiritual and social pre- and post- share externally with Local Resilience Forums, CCGs Coronavirus • Specialist day services bereavement and regulators. • Providing access to psychology (COVID-19) Palliative care: By daily tracking, reporting and investigating suspected Inpatient services: 24 hour co-ordinated palliative care advice: outbreaks, shortages in PPE, non-consumables and • 24/7 admissions that seek to ensure equitable • Signposting advice and guidance medication supplies, assessing the impact of the infection care for all and inclusive of the ‘hard to reach’ • Support for individuals to signpost to the pandemic on staff wellbeing, our services remain safe Visitor update • Beds managed by a specialist medical and appropriate service and effective. In ensuring our care environments are Following updated government advice to help nursing team • Rapid response and crisis support safe for staff and the people in our care, each unit was tackle the Coronavirus • Offering physiotherapy, occupational therapy, risk assessed with workflows mapped and redesigned emergency and to protect our vulnerable patients complementary therapies, social workers and Befriending: to apply strict infection prevention and control and and staff it is with a heavy heart we have completely spiritual care • Maximised by the use of volunteers social distancing. closed our hospice/centre • Delivering individual programmes of care linked to to visitors. For details & exceptions personal goals and preferences Online Bereavement Support services: visit www.sueryder.org • Online peer support Hospice at Home: • Online Bereavement Counselling • Domiciliary visits • Online information resources Poster informing • Medical and family support family and friends of government advice on Sue Ryder is a charity registered in England and Wales (1052076) visiting at our hospices and in Scotland (SCO39578). Ref. No. 07176. © Sue Ryder. March 2020 (second edition). and centres.

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Part two: Our priorities for improvement 2019–20 2.1 Progress against our priorities for improvement 2019–20

At Sue Ryder we are continually focused on improving the quality of our care as Our priorities for 2019–20 were: demonstrated in our achievements of our quality priorities. To support us with this, the way data on performance has been used to inform improvements to care Priority 1: Service user experience delivery has been improved during 2019–20. Priority for Improvement: To work collaboratively with our staff and service users to review and enhance our approach to service user involvement and engagement for all This has encouraged rich conversations about care Trustees with oversight of key aspects of regulated our services. quality and to allow service leaders to triangulate care across all Sue Ryder services. factors that influence or affect care delivery, escalate concerns and share learning from their quality During the reporting year three hospices were improvement activities. Services now see integrated inspected by the Care Quality Commission and all Priority 2: Service user safety quality reports monthly with information (key improved their rating from Good to Outstanding. Priority for Improvement: To strengthen shared learning across the organisation, performance indicators) about harm free care, activity Two neurological care centres were also inspected, internally and externally, with a focus on quality improvement initiatives to reduce falls, such as length of stay, staffing and leadership. This one improving their rating from Good to Outstanding medicines and pressure ulcers in palliative and falls, medicines and behaviour that detail is then aggregated to provide senior leaders and and another maintaining a rating of Good. challenges in neurological.

Priority 3: Service user effectiveness

Priority for Improvement: To continue to enhance the care culture by using a human rights approach to end of life care and implement a sustainable model.

Priority 4: Service user experience

Priority for Improvement: To strengthen our awareness of mental health and dementia for all our services.

Priority 5: Service user and staff safety

Priority for Improvement: To further develop our workforce planning incorporating new models of care delivery.

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2.2 Priority 1 Case study

Clients at one of our specialist Clients have also been having their say on menu and We said we would: We have encouraged all our centres to adopt the neurological care centres have been activity choices at the centre. A week of activities Work collaboratively with our staff and ‘You Said, We Did’ boards, which are displayed in helping to choose artwork to brighten was organised around the mealtime experience and service users to review and enhance our our reception areas to clearly demonstrate what we another week on mental wellbeing. are improving from service user feedback. We have the walls of their new home. approach to service user involvement updated our real time feedback surveys, and plan to ‘go The first week encompassed menu choices and the and engagement for all our services. live’ in quarter 1 of 2020–21. This was in collaboration Sue Ryder staff and clients have also created pieces ambience of the dining room and saw clients try their with every centre and their service user groups who of artwork to take with them and hang in the new hand at bread-making and smoothie-making. Staff • To implement the new models and review their were asked to review and update the number of Sue Ryder Neurological Care Centre Lancashire. collected feedback on all the activities and new foods effectiveness to drive quality improvement questions asked on each survey. The new Friends and The charity Paintings in Hospitals held a special were introduced to the centre’s menus as a result. • To develop skills and resources in person centred Family test question will also be included. workshop at Sue Ryder Neurological Care Centre engagement methods. Cuerden Hall. As well as creating their own works of Bespoke yoga sessions were organised for mental For our new centres, Sue Ryder Dee View Court and art, clients looked through a book of paintings and wellbeing week and clients were able to learn How this will be monitored and measured: Sue Ryder Lancashire, we have created leaflets for had the opportunity to vote for their favourites. The techniques for coping with anxiety. Regular yoga • Feedback will be monitored at service level and our prospective clients in conjunction with our current most popular pieces will be hung on the walls of the sessions have now been introduced as a result of the through corporate governance to include response service users, to enable us to really understand what new centre. clients’ feedback. rates for real time feedback. matters to a person when they come into our care. Service users have also been working with local Initiatives like this aren’t just about creating The sessions enabled staff to take a more in-depth look artists to choose artwork that will be on the walls of stimulating spaces for our clients and staff. When at what clients like and don’t like and helped to identify We did: their new centres. people have the opportunity to make a real the changes that would make a positive impact. We have refreshed the service user participation contribution and they can see their input is valued strategy by consulting with service users at each of our Case studies/service user stories are being shared via and appreciated, it helps to promote better health services to understand how they wanted to engage social media, and every Sue Ryder Trustee Council and wellbeing. and collaborate with healthcare staff to improve their meeting commences with a case study which enables experience of the care. the voice of service users to be heard at all levels of the organisation.

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2.3 Priority 2 Case study

Jan Skipworth-Button, Quality and Improvement Fiona Hinde, Lead Nurse at Sue Ryder’s Neurological We said we would: meetings, all the clinical representatives discuss and Manager at Sue Ryder Palliative Care Hub South Care Centre Lancashire, said interrogating Datix Strengthen shared learning across the share best practice and challenges in an ‘All Teach, All Oxfordshire and Sue Ryder Duchess of Kent Hospice, reports can also provide some useful learnings for organisation, internally and externally, Learn’ environment. Each work stream has a quality believes the workstream meetings strengthen best staff. “Where there has been an error our care staff improvement project to deliver. practice across the organisation. She said: “Each and nurses are asked to reflect on what they might with a focus on quality improvement centre has ideas and examples of how they have do differently. We also liaise with Sue Ryder’s other initiatives to reduce falls, medicines Collaborative working: reduced falls or medicine incidents which other neurological centres and share best practice via the and pressure ulcers in palliative and We have undertaken a local evaluation of PURPOSE-T centres can take on board and use; we can learn specific workstream meetings.” falls, medicines and behaviour that (a pressure ulcer risk assessment tool developed by the from and support one another.” University of Leeds and Leeds Teaching Hospitals NHS Sue Ryder’s central Quality and Governance challenges in neurological. Trust), in two of our hospices and one neurological Jan added: “The introduction of the ‘Safety Cross’ team delivered training on Quality Improvement service. Early evaluation data shows this provides a has been used successfully to track falls and methodology for staff. Ward Sister Mari Pittman at • To share best practice across palliative and more holistic assessment of a person’s likelihood to medicine management incidents and displayed the charity’s Sue Ryder Leckhampton Court Hospice neurological services develop a pressure ulcer. in staff areas to enable a sense of ownership. The said: “The QI session encouraged all staff, whatever • Each service to demonstrate quality improvements Safety Cross provides real time incident data which their role, to feel comfortable to present any new using agreed quality improvement methodology We are working in collaboration with the Improvement can be linked to an improvement plan.” ideas or different ways of working which would be and measure progress. Academy based at the Bradford Institute for Health beneficial to all and improve our practices. Research which is one of the leading specialist How this will be monitored and measured: quality improvement support agencies in the UK • Quality improvement displays in staff areas to implement their HUSH (Huddle up for Safer • Quality visits showcasing improvement and the Healthcare) programme. This is an evidence-based implementation of shared learning intervention that has been demonstrated to improve • Learning for safety memos acted on staff team-working and culture, and to reduce patient • Incident and performance data. harm. The first testing has been implemented at Sue Working in the roles that we do, we are best placed to Ryder Manorlands Hospice and, although in its infancy, recognise where change may be needed. It may be We did: feedback has been very positive. This approach will be implemented into a further two of our services within that it starts with an initial idea which requires building Quality Improvement: the next year. In collaboration with staff, we have implemented upon and trialling before we get to the final stage of ‘quality boards’ in services which provides a visual improvement. We were encouraged not to be worried display for all members of staff to understand what is happening in their service. The ‘Quality Visits’ about presenting our new ideas, no matter how (assurance) process has been revised and tested, and now incorporates a sharing of best practice, discussion insignificant it may seem. Small changes can make a with Directors about their quality improvement events big difference. and time to celebrate the successes of each service.

Quality Improvement (using the Model for Mari Pittman Improvement) has been driven through the following Ward Sister, Sue Ryder Leckhampton Court Hospice multidisciplinary and workstreams: falls prevention, medicines management, safeguarding, behaviours that challenge (neurological services), pressure ulcer prevention and infection prevention control. At the

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2.4 Priority 3 Case study

We said we would: “The content was relevant to all staff present, Continue to enhance the care culture by using a human rights whether working in EOL or not, which I found very useful. Explanations were clear and thorough, approach to end of life care and implement a sustainable model. scenarios relevant and real. The shock factor that these things could happen for real really drove How this will be monitored and measured: home the importance of staff familiarisation with • An increase in the number of trained trainers who will ensure this work is shared across everyone’s rights and responsibilities – patients and their health and social care communities across all four UK nations staff. Trainer’s pacing and delivery was excellent. • Training compliance rates Posed interesting questions and exhibited thorough • An evaluation of the training as an approach for improving end of life care delivery. knowledge of subject matter – thank you”. NHS Academy Trainer

We did: “The whole team are buzzing from the event We trained a further 30 trainers across the UK by the end March 2020, creating a network yesterday. It is hard to get everyone prepared to of 127 trainers in total. Of those 30 additional trainers, seven are Sue Ryder staff. We have give up a clinical day but your workshop certainly trainers in England, Scotland and Northern Ireland and we are planning to develop the first achieved this, and more. I would like to forward my trainers in Wales in June 2020. The trainers who are not employed by Sue Ryder have gone thanks on behalf of myself and the whole team”. on to educate at least a further 660 health and social care staff in the past year. Some of Practice Development Nurse the trainers have embedded the approach into existing Safeguarding and Mental Capacity training, or into under-graduate or post-graduate academic courses, so the reach and impact is growing rapidly.

Training compliance for Sue Ryder staff has continued to improve and the introduction of an e-learning Refresher Module was issued a year after the face-to-face training to refresh What an amazing day yesterday. Everyone is talking existing knowledge. about it today and the MND coordinator is also looking We are working to complete the final evaluation with support from the at Train the Trainer on behalf of MND Association. University of Birmingham and hope to have it published during 2020. Hospice Social Worker

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2.5 Priority 4 Case study We said we would: We did: Dementia Together is a Peri-Diagnostic community support service led by Sue Ryder The Chantry covering the county of Suffolk. Our staff on the programme Strengthen our awareness of mental We connected staff to new learning resources on health and dementia for all our services. e-learning for Health (Health Education England have completed a Dementia Care Coaching Course enabling them to support programme) via our internal Learning Management people living with dementia and those who care for them. • Increase our knowledge through education System (LMS): Mental Health Awareness, Learning • To assess and improve the care environment. Disability Matters, Autism Spectrum Matters and Staff visit people in their homes and provide advice also attend to deliver sessions on subjects such as Dementia Awareness. and information on how to live well at home for as nutrition and diet, speech and language and power How this will be monitored and measured: long as possible. They also run small group sessions of attorney. • Training compliance rates Our palliative services are supported to complete for people with dementia and their carers. Alana • Quality audit and assessment of regulatory this training to meet the requirements of the Care Page, Community Services Operations Manager at Our ‘Positive Living’ group is aimed at people living standards. Quality Commission framework with over three Sue Ryder The Chantry, said: “Our team of Dementia with dementia (early to mid-stages) and their quarters of relevant staff already trained. Compliance Navigators support people with information and partners/carers. It takes place once a week for four is closely monitored by our centre educators and education around how they can manage to live weeks providing a relaxed and safe environment for We did: Professional Lead for Education, as well as through our well with their condition. We provide practical and people to share information and experiences and We reviewed training requirements across our Integrated Quality and Performance Report (IQPR) and personalised awareness sessions to meet individual support others in a similar situation. neurological and palliative services in relation to meetings. In addition, quality visits from our Quality needs that have proven to be really powerful for a mental health and dementia awareness learning and Governance team across all our services supports carer in everyday coping.” At Sue Ryder Wheatfields Hospice in Leeds, staff needs. Following this, awareness courses were sourced them to complete quality audits to ensure compliance are benefitting from person-centred dementia resulting from a scoping exercise and delivered either of regulatory standards. In addition to the one-to-one support we provide via care training devised by the University of Bradford, at a local level and/or via e-learning for Health Modules home visits and the helpline, this year we added to Centre for Applied Dementia Studies. The training (e-learning for Health). Sue Ryder Practice and Clinical Educators also work the education element of the service. Monthly ‘We has an end-of-life care component for hospice staff closely with their local networks and develop face-to- Care’ sessions are held for carers providing support and is initially delivered by experts in the fields of Increased knowledge around mental illness, face training. with topics such as understanding dementia, dementia care and palliative care to hospice staff highlighting the link between mental and physical managing behaviours, communication, rights and who then become ‘peer facilitators’ and roll the health diagnoses, will enable assessment and entitlements and wellbeing. Outside speakers training out to colleagues. improvement in our care environments, by providing simple guidance on how best to care for someone with mental health difficulties, which can easily be transferred into practice.

Understanding how common dementia is and what it is like to live with its symptoms for both the person and the family, will improve the care environment we provide by helping people affected by dementia to live as well as possible.

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2.6 Priority 5 Case study

We said we would: We did: Our new values and behaviours and networking groups, get involved in new activities Further develop our workforce We undertook a ‘Cultural Audit’ to better understand launched in February 2020 including and team events and most recently she supported planning incorporating new models the feelings and requirements of the organisation. case studies from our organisation my application to do an advanced diploma in the field Over 500 people took part in this audit and afterwards I work in. This support was not only financial: she was of care delivery. we undertook further consultation and discussions that demonstrate them. One value also happy to help and guide me through any issues with each part of our multi-faceted organisation. As a is Supportive which says “We’re here or concerns I had with the course assignments until Develop our leadership and result, we launched our new core values of Connected, for people when it matters, and that successful completion. management capabilities and Supportive and Impactful in February 2020. Each value includes each other. We encourage, has a set of behaviours attached to it which provide the “She has also always encouraged me to apply for new workforce behaviours and create whole organisation with guidance of how the values will inspire, help one another and opportunities and most recently this has led to me a culture of learning and feedback, be demonstrated in the organisation. These behaviours celebrate success.” successfully moving to a secondment. This also required wellbeing and safety. directly support and guide our line managers. the support and ‘leap of faith’ from my new manager. Having your manager’s support makes you feel valued We have designed and launched a suite of face-to- “I would like to share how supportive my manager has as a person and as a team member. It gives you the How this will be monitored and measured: face courses to improve the skills and knowledge of been in helping me to develop and further my skills confidence to believe in yourself and your abilities, which • Annual Let’s Talk survey results our line managers. These courses include: Feedback and career. She has encouraged me to attend courses in turn will help to deliver more positive outcomes.” • Training attendance rates (Leadership and Skills, Handling Difficult Conversations, Recruitment Management programmes) and Selection, Performance Management, Personal • Wellbeing and safety in the workplace e-learning. Impact, Mental Health Awareness for line managers.

We have supplemented face-to-face sessions with We did: numerous e-learning opportunities for both paid staff We established a defined focus on workforce planning and volunteers. We have invested in developing a by creating working groups both at operational and learning and development culture for all using modern strategic levels. The operational groups identified key e-learning practices, development pathways, new areas of improvement for recruitment, agency usage techniques and a consultative approach. In addition and safe staffing. The strategic group is revising a to this, we have reviewed and updated our current Workforce Strategy to enable us to meet the changing Performance Management system and invested in an needs of our service users and families in the future. online system which is currently in design stage.

This involves understanding how the new workforce We have designed and delivered a Mental Health will be shaped and established, what skills and training Development Pathway for all members of Sue Ryder. are required and how we can continue to use effective This offers development activity at different levels for succession planning to attract and retain our great all members of staff from operational level through clinical teams. to the Executive Team and also an option for our volunteers. The pathway uses a variety of different We have a suite of leadership and management learning methods such as: e-learning, face-to-face courses and programmes to develop and challenge sessions, remote learning and mentoring. these roles and individuals. These modules and service improvement projects will focus on creating and implementing a culture of continuous learning and feedback.

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2.7 Our priorities for 2020–21

Quality priorities for 2020–2021 have been developed based on themes of clinical incidents, concerns, service user feedback and consultation with staff from across the organisation.

Priority 1: Service user safety Priority 3: Service user and staff safety Priority for Improvement: Priority for Improvement: To continue our commitment to ensure that service users are kept free from harm with a special focus this To ensure safe and effective care by having the right numbers of nursing staff with the right skills and year on reducing our falls incidents. We will implement the HUSH (Huddle up for Safer Healthcare) model knowledge in the right place. We will work with experts in the field to develop appropriate models of safe in three of our palliative care centres. This model is designed to support the reduction of falls and following staffing for our services. its evaluation we will implement it across all of our palliative and neurological centres. How this will be monitored and measured: We will establish evidence-based methods to monitor safe staffing levels and measure on a monthly basis How this will be monitored and measured: through performance monitoring. For the three palliative care centres we will monitor the falls rate (number of falls per 1,000 occupied bed days) and the number of days between falls occurring in order to identify the impact of the HUSH model. Success will be measured as a sustained reduction (over a 6 month period) in the falls rate.

Priority 4: Service user experience Priority 2: Clinical effectiveness Priority for Improvement: Priority for Improvement: To improve the wellbeing of service users in our palliative care centres. We participated in the Physical To ensure service users in our neurological care centres are able to maximise their potential and maintain Activity in Palliative and Neurological Care Clinical Practice recommendations Research Study with the greater independence, where possible. We will enable this with the implementation of rehabilitation University of Leeds and we will implement the recommendations of this. Following implementation in models of care. palliative care we will look to extend this work to our neurological care centres although the timescale may extend beyond this financial year. How this will be monitored and measured: We will monitor the progress of all service users admitted to our centres for rehabilitation using a set of How this will be monitored and measured: nationally recognised, validated tools designed to measure change across a wide-ranging set of daily-living To measure improvement in wellbeing we will gather feedback from service users and their families on activities. In addition to these clinical outcomes we will collate feedback from service users, their families perceived wellbeing as a result of physical activity. and healthcare professionals.

26 27 Part two: Our priorities for improvement 2019–20

2.8 Statements of assurance

This section contains the mandatory statements of assurance required of all providers of NHS funded care within their Quality Account. The information provided is relevant to the services Sue Ryder provides.

During the period of this report, 1st April 2019 to audit programme is risk-driven, and for hospices and 31st March 2020, Sue Ryder provided NHS-funded neurological care centres includes record keeping, community care services in our hospices and some medicines management, falls prevention, manual care centres and NHS-funded nursing care in most of handling, pressure ulcer assessment and management our centres. Sue Ryder had seven adult inpatient units and infection prevention and control (including within hospices, seven day hospices, three Hospice at environmental and hand hygiene audits). Home services, four community nursing services, and four care homes with nursing (three in England and The reports of 11 local clinical audits were reviewed from one in Scotland). In addition to these services we also 1st April 2019 to 31st March 2020, with high compliance delivered care within two supported living services. observed across the board. As a result of the audit programme Sue Ryder intends to take the following Sue Ryder has reviewed all the data available to it on actions to improve the quality of healthcare provided: the quality of care in all of the above services. • Continue with the shared learning and spread The income generated by the relevant health services of best practice across the organisation through reviewed in year ending March 2020 represents 57% the specialist interest groups in: falls prevention, of the total income generated from the provision of medicines management, safeguarding and pressure relevant health services by Sue Ryder for year ending ulcer care March 2020. The % statutory income received for palliative services was 41% and neurological services • Revise and increase the frequency of infection was 85% during the year (the total across both being prevention and control audits designed to ensure services 57% for the period). safe practice to prevent the spread of Covid-19.

During the period from 1st April 2019 to 31st March 38 patients were recruited at Sue Ryder during the 2020 there were no national clinical audits or national financial year 2019–20 to participate in research confidential enquiries covering the NHS services that approved by a research ethics committee within the Sue Ryder provides. National Research Ethics Service.

The reports of 0 national clinical audits were reviewed A proportion of Sue Ryder income in the year ending by the provider from 1st April 2019 to 31st March March 2020, was conditional on achieving quality 2020. Whilst the mainstay of national audits is directed improvement and innovation goals agreed between at the hospital setting, Sue Ryder acknowledges the Sue Ryder St John’s Hospice and Bedford CCG, through benefit of learning from the wider health and social the Commissioning for Quality and Innovation care sector. Going forward the newly appointed Chief payment framework. The agreed goals and applicable Medical Director will be reviewing relevant national quality requirements (see Schedule 4 Parts A-D of audits and sharing learning across the organisation. the national NHS Standard Contract) for year ending Sue Ryder sets an annual core audit programme March 2020 are detailed within an agreed service that runs from April to March each year. The core specification.

28 29 Part two: Our priorities for improvement 2019–20 Part two: Our priorities for improvement 2019–20

2.8 Statements of assurance (continued) 2.9 Indicators for quality

Sue Ryder is required to register with the Care Quality • Increased awareness in the importance of reporting Safety Commission and the Scottish Care Inspectorate. • Implemented integrated quality and performance Conditions of registration include the management by reporting from unit to Council (ward to board) Number of incidents affecting service users 2019–20 an individual who is registered as a manager in respect • Identifying trends through a balanced scorecard of that activity at all locations and maximum number of reporting system Service user incidents and harm Neurological Palliative Homecare beds for its services in the following regulated activities: • ‘Learning for safety’ memos for when systems and 2018–19 2019–20 2018–19 2019–20 2018–19 2019–20 processes change. No. of incidents affecting service user/clinical incident 462 756 915 1078 98 68 • Accommodation for people who require nursing No. of incidents resulting in severe harm 0 1 2 4 0 0 or personal care During the period 1 April 2019 to 31 March 2020, Rate of incidents resulting in severe harm 0.0% 0.1% 0.2% 0.4% 0.0% 0.0% • Diagnostic and screening procedures 1,234 Sue Ryder patients died (1,214 in our palliative in Note: Severe harm relates to those recorded on Datix as ‘permanent or long-term harm’. The data from 2018–19 has been updated as a result of further validation. • Personal care patient units and 20 in our neurological care homes). Of the five incidents resulting in severe harm, four people experienced a fracture as a result of a fall. Investigations • Transport services, triage and medical advice This comprised the following number of deaths which revealed underlying health conditions affecting bone health as contributory factors. One incident was as a result of provided remotely occurred in each quarter of that reporting period: [265] a medication incident. • Treatment of disease, disorder or injury. in the first quarter; [303] in the second quarter; [327] in the third quarter; [339] in the fourth quarter. These Regulatory inspection results 2019–20 The Care Quality Commission has not taken figures are comparable with deaths during 2018/19. Inspections by the Care Quality Commission in 2019–20: enforcement action against Sue Ryder from 1st April 2019 to 31st March 2020. The deaths in our services were expected deaths, May 2019 The Chantry Outstanding and by 31 March 2020, 0 case record reviews and 0 October 2019 St John’s Hospice Outstanding Sue Ryder has not participated in any special reviews or investigations have been carried out in relation to the December 2019 Duchess of Kent Hospice Outstanding investigations by the CQC during the reporting period. deaths included above. December 2019 Stagenhoe Good December 2019 Thorpe Hall Hospice Outstanding Sue Ryder was not required to submit records during In response to findings in the Gosport report, the the period from 1 April 2019 to 31 March 2020 to the following declaration identifies how staff are guided There have been three inspections by the Scottish Care Inspectorate in 2019–20 in Sue Ryder secondary uses service for inclusion in the hospital to raise concerns and speak up if they have concerns services in Scotland: episode statistics. over quality of care, patient safety or bullying and harassment within the organisation. May 2019 Stirling 6-Excellent for areas inspected All organisations that have access to NHS patient December 2019 Arbroath 5-Very good for areas inspected January 2020 Dee View Court 6-Excellent for areas inspected data and systems are now required to publish a Data Staff are guided to follow guidance in a revised Security and Protection Toolkit (DSPT) self-assessment Whistleblowing (Raising Concerns) Policy and to provide assurance that they are practising good approach their line manager in the first instance where Effectiveness data security and that personal information is handled appropriate: correctly. The publication date for this year has been Healthcare Associated Infections 2019–20 extended until 30 September 2020, and Sue Ryder 1 Internal disclosure to their line manager will be publishing their DSPT by this date, with all 2. A member of the Senior Leadership Team in their area No cases of Clostridium Difficile were acquired within a Sue Ryder service and only one case standards met. 3. A member of the People Team acquired prior to the patient being admitted to the hospice. 4. A member of the Executive Leadership Team Clostridium Difficile Sue Ryder was not subject to the Audit Commission’s 5. The Chief Executive 2018–19 2019–20 payment by results clinical coding audit during the 6. The Chairman of the Trustees. SR Out SR Out period 1 April 2019 to 31 March 2020. Total 1 1 0 1 Should an internal response not address concerns, Rate per 100,000 occupied bed days 1.3 n/a 0 n/a Sue Ryder will be taking appropriate actions to improve staff are guided to seek independent advice and SR = Acquired within Sue Ryder data quality through: contact the External Regulators. Out = Acquired external to the service

30 31 Part two: Our priorities for improvement 2019–20

2.9 Indicators for quality

We use a number of ways to measure service user similar care and treatment. Relatives of those satisfaction including real-time feedback surveys. people using our services are also encouraged The questions we ask relate to their experience to provide feedback particularly for service of the care and support they receive, how well users with complex conditions or who may have they are treated by us and whether they would communication difficulties. recommend our services to others if they needed

Neurological care 2019–20

In our neurological care centres we support people with complex conditions, many of whom have communication difficulties and therefore are not able to respond to the survey questions. To increase service user feedback we have introduced a survey for relatives to complete on their behalf. We will be reviewing other ways to support our service users to have their say.

On the day before her discharge Kate gave this comment about how she has benefitted from her time at Sue Ryder.

On being here I can see the problems that I have. At the hospital I didn’t realise I had them. Being here they let me do things and I realised what I couldn’t do. If I had gone straight home my husband wouldn’t have known what to do. He wouldn’t have learnt half the stuff he has learnt here. I think something bad would have happened.

I would like to show my appreciation to everyone for the results I received by being in your care. I came to you with very limited movement and had goals to reach for going home, which at times I was petrified of, as I could not imagine ever managing.

The Sue Ryder Stagenhoe team from the Cleaners, Recreational, Clinical and Rehab teams are amazing and have given me my life back, which I will never forget.

Can never thank you and the rest of the team enough for the care and love you gave while at Stagenhoe. You are all quite exceptional in the way you work with the people who need such care.

32 33 Part two: Our priorities for improvement 2019–20 Part two: Our priorities for improvement 2019–20

2.9 Indicators for quality

Palliative care

The care is around the clock. It’s just tweny four hour total The care is so good and the Because of the care I need They go the extra mile and try care – you cant beat it. Everyone Nurses are wonderful – they are nothing is too much trouble. No and accommodate your every is so caring and they all have a so helpful and happy. Nothing request is too small. Everything need. Everyone is friendly sense of humour. They are all is too much trouble. The free is done with humour. They are and chatty. It is not just the very personalised. visiting is great – especially if always checking on me. nurses and doctors who are you have family living away. great – everyone is – catering, When you come in you get domestic, volunteers. a warm feeling. It is lovely and calm quiet and peaceful. Would have to go a long way to They seem to have got find some where more caring everything right here. The staff The attitude of everyone here and understanding. they listen – everyone and volunteers – to you. work as a team. is so caring and sensitive. 99% of service users in our hospices

of service users in our 99% hospices 98% of service users in our hospices are likely or extremely likely to recommend our care to feel they are always treated with rate overall care as friends and family if they needed similar care or treatment respect and dignity by staff excellent or good

34 35 Part two: Our priorities for improvement 2019–20 Part two: Our priorities for improvement 2019–20

2.9 Indicators for quality 2.9 Indicators for quality

Community, home care and supported living services 2019–20 Formal complaints about care 2019–20

Complaints Acknowledged 3 days % Responded 20 days % Staff very helpful Mum is delighted and Neurological 8 7 88% 6 75% Palliative 8 7 88% 5 63% and understanding all dealings with staff Home Care 2 2 100% 2 100% of my needs. for me is excellent. Total 18 16 89% 13 72%

My carers are an Complaints Upheld Not upheld Partially upheld Ongoing excellent team and Number 18 9 4 5 0 99% respect your dignity % 0% 50% 22% 28% 0% of service users at all times, they are in our Scottish all kind, thoughtful We define a formal complaint as ‘an expression of reply within 20 working days. Of those complaints Homecare services discontent to which a response is required’. With where the complainant requested a formal response, agreed or strongly and caring. They reference to our complaints policy, the complaint is in 13 out of 18 instances the 20 working day target agreed that they are have made my life considered formal when it is received orally, in writing was met. Where the target time was not met, the respected and treated or electronically and cannot be resolved within 24 complainant was in all cases sent a holding letter to with dignity as an much better. hours of receipt. explain the delay. individual There were 18 formal complaints about care during The themes from complaints are very important. They Your lovely ladies 2019–20. help us to learn and to improve the overall experience for individuals using our services. The number of are “angels”. I do The target in the complaints policy for the initial holding complaints across all service areas is low, but we have not know where I response to complaints is three working days. Where reviewed those received and the following themes the complaint was initially received by a service, and have been identified (please note there may be would be without where the complaint was by a named complainant, multiple issues in one complaint): them. Thank 89% were acknowledged within the timescale. • Communication you for all your The target in the complaints policy for the final written • Staff attitudes/behaviours response to a complaint is 20 working days. However, • Care quality. kindness, empathy the policy does acknowledge that in some instances 89% and compassion. this is not possible. This would usually be where the All complaints are raised within local Quality investigation is complex. In these cases all services Improvement Groups at individual services. Feedback of service users in our Scottish Homecare The service aim to maintain contact with the complainant, giving and learning to the local teams regarding improvement services are likely or extremely likely to you provide is a report of progress and in all cases sending a holding measures is monitored locally. recommend our service to friends and family if they needed similar care outstanding.

36 37 Part three: Other information Part three: Other information

3.1 Linda’s story (case study) 3.2 Lee and Jean’s story (case study)

Mother-of-three Linda Barnard, 51, was taken seriously ill with Guillain-Barré Lee Jackson, 44, signed up for the trip of a lifetime to the Great Wall of China after Syndrome (GBS), a very rare condition that affects the nerves and can be life- his mum Jean received end-of-life care at Sue Ryder Manorlands Hospice.

threatening. Linda was left unable to walk so when she was given a chance to “My mum was diagnosed with lung cancer in February Since his mum’s death, Lee has also been supported go to The Chantry, Sue Ryder’s specialist neurological care centre, for intensive 2018. She didn’t want any treatment and in March last by a Sue Ryder Bereavement Counsellor. “My dad rehabilitation she seized the opportunity. year she was obviously coming towards the end. We died six years prior to my mum and they were both had heard really positive things about the Sue Ryder relatively young which has been difficult to deal “I can’t remember anything about being in A&E. home for my children. I had a really clear idea of what team and fortunately there was a bed available for with, but life carries on and you have to keep going. My breathing deteriorated and I went straight into I wanted to achieve and the Sue Ryder team’s attitude mum at Manorlands Hospice. She was deteriorating The bereavement counselling I have received from intensive care and was put on a ventilator for about with me was great which gave me that little extra really quickly so we were only there for four or five days Manorlands Hospice has been a great help and a great 10 days. push that I needed at times.” in the end, but the Sue Ryder staff just went above and comfort. I was in quite a dark place and just being able beyond the call of duty. Mum passed away on March to talk to someone made a huge difference. Rather “I couldn’t close my eyes properly, I couldn’t move With the support of the inter-disciplinary team at Sue 26. Just because of the amazing support we had while than thinking about what I might do in the future, it has my legs or arms, I couldn’t speak. Because my Ryder’s specialist rehabilitation unit (Level 2), Linda we were there, I felt I had to give something back.” encouraged me to plan for what I will do.” lungs weren’t functioning properly I ended up with returned home to her family walking with a stick and double pneumonia and back in intensive care. I was has since been able to return to work and driving. Lee donated funds from his mum’s funeral to Sue Mum passed away on March 26. in hospital for two-and-a-half months. I desperately “I have come on in leaps and bounds. The service I Ryder Manorlands Hospice and also embarked on a Just because of the amazing support wanted to leave but I knew I needed more received from Sue Ryder is absolutely vital. Every day I fundraising trip. The 10-day trek along the Great Wall we had while we were there I felt I physiotherapy so the news that I could go to rehab am just overjoyed at still being here. The hospital kept of China proved to be a bonding experience for the was amazing. me alive and… participants, with many having embarked on the trip in had to give something back. memory of a loved one. “I went to Sue Ryder The Chantry at the beginning of …Sue Ryder, The Chantry has June 2019 for two months. I went into The Chantry enabled me to do things I thought in a wheelchair, I couldn’t even stand. Being a single I might never be able to do again. mum was quite an incentive. My goal was to get It has given me my life back.

38 39 Part three: Other information Part three: Other information

3.3 Sam and Ben’s story (case study) 3.4 Penny’s story (case study)

Sam Sykes’ husband Ben, 36, was diagnosed with stage 4 incurable and inoperable Penny’s husband Colin died in 2009, five years after he was first diagnosed with a bowel cancer in January 2019. He spent the last five weeks of his life at Sue Ryder rare degenerative brain disease. Penny was Colin’s main carer and he was able to Leckhampton Court Hospice where he was able to spend precious time with both die in his own home surrounded by his family. 10 years on and Penny, a Nursing Sam and their two-year-old daughter Erin. Assistant, now helps other families in a similar situation as part of the Hospice at Home team at Sue Ryder Palliative Care Hub South Oxfordshire. Ben died on July 16, 2019. Sam is determined At the hospice Ben could be; a to ensure other families benefit from the same father, a husband, a son and a friend. “The year after Colin died I went to work in the to them! I find people often find comfort in music. It specialist palliative care when it matters. Supported community as a support worker which was my really does break the ice and often they will join in and by family, friends and colleagues she has set up an We were able to be a family and I daughter’s idea. I did that for four years and I also sing with me. It’s things like that which make the job so Incredible Memories Fund tribute page for Ben and was able to be a wife, and he wasn’t worked for the ambulance service for five years but wonderful – when you can break down a barrier. is hoping to raise £36,000 for Sue Ryder. just another patient. when I saw Sue Ryder were advertising for the Hospice at Home scheme I just thought ‘that’s the job!’ After We have a fantastic team we really “Leckhampton Court is honestly the most magical “In memory of Ben our aim is to simply ensure we going through what I did with my husband I felt I would do and I wouldn’t want to work and inspirational place and we were truly blessed can help as many families as possible to have the love to be able to work in palliative care, to be able to to have been there. Ben just wanted to live and same time to create their own priceless memories.” use my own experience to support other people in anywhere else. No day is the same laugh. To make the most of every single day we getting through it. and I never wake up thinking, had left together. And this happened because of ‘I don’t want to go to work today’. every element of Leckhampton Court. It happened “I remember going for the interview and I really felt it It’s a privilege to be on that journey because of the doctors who cared about Ben’s was the job I was meant to do. They rang me that very every comfort. It happened because of the nurses same day and offered it to me. I have been with Sue with someone and to support them who took the time to really get to know us, and Ryder now for almost two years and I absolutely love it. through it. to understand our often inappropriate sense of Some people are unsure about intervention from the humour. It happened because of the care assistants outside world but it’s about gaining their trust. I sing who got to know how important it was for us to still enjoy our evening gin and tonics on our hospice date nights and who cheered us on in our newfound jigsaw obsessions. Because of the chefs who worked so hard to find meals, Ben could actually try and eat. It was because of the cleaning staff who so patiently let our little girl try and help with the mopping of Daddy’s room. It was because of the volunteers who keep the grounds so peaceful and tranquil, because of the sewing group who made the most beautiful memory blanket for our daughter, because of the compassionate words from the staff in reception. It happened because of the newfound friendships that were forged out of shared experiences.

“And finally, because on July 16, the hardest day of my life, the staff were there when I needed them the most, to hold my hand and prepare me every step of the way.

40 41 Part three: Other information Part three: Other information

3.5 Kirsty’s story (case study) 3.6 Hannah Halliwell, Rehabilitation and Therapy Service Lead (case study) Kirsty McEwen, 31, ran the Royal Parks Half Marathon and raised £1,105 for Sue Ryder Duchess of Kent Hospice which cared for her The new purpose-built, state-of-the-art Sue Ryder Neurological Care mum, Julie, in her final days. Centre Lancashire has presented us with the opportunity to transform how we deliver rehabilitation services in 2020. “Mother was diagnosed with oesophageal My mum and dad were able to go on a couple cancer in June 2017, a month after I of holidays, and then in May 2019, she became got married. She was 59 when she was really unwell again. At the beginning of August, Our Rehabilitation and Therapy Service Lead, more frequently and build the strongest diagnosed. They said she might live two years doctors said there was nothing more they Hannah Halliwell, has been working on a new relationships with them so we are going to with treatment. could do and gave Mother three weeks to live. model of service delivery that will enable us to upskill and utilise that workforce.” On her final weekend we contacted Sue Ryder offer a more comprehensive service for clients. “In January 2019 they said she was free of and she went to the Duchess of Kent Hospice Under the new model, specialist training cancer: although we knew it was always going on the Tuesday morning. She died four days With the addition of 14 neurological has been devised for rehabilitation therapy to come back, it was just a question of when. later on the Friday. rehabilitation beds comes the need for a assistants covering 10 key areas of learning larger workforce and comprehensive training which will be underpinned by competencies, is being developed and put in place to enable training and supervision. Each assistant will the career development of existing staff. also be allocated a qualified therapist as a Everyone there was so good. When mentor and supervisor. Hannah said: “We all recognise the expertise the doctors came in to talk to us, they of our physiotherapists, occupational Sue Ryder Lancashire also currently has four therapists, speech and language therapists care staff undertaking a foundation level actually spoke to my mum and were and psychologists but I think the assistant degree at the University of Central Lancashire workforce can be underutilised. Often these who will qualify as therapy assistant so respectful even though she couldn’t are the people who are with the patients practitioners next year. respond anymore. When she died, the staff prepared all the documentation There is a real commitment to the we would need for the registrar so learning and development of assistant quickly which was really helpful at such therapy staff here. The new model a difficult time. will offer great career development opportunities for staff and ultimately “I already had a place for the Royal Parks Half I was definitely a bit wobbly and it was really Marathon so I decided I wanted to use it to nice to have my family there for support. It it’s about delivering the best care for give something back. It was only my second was an emotional day, but hopefully I did my half marathon and my training had been a mum proud and also helped other families our patients. bit erratic when my mum was so ill. The race going through something similar.” was only a month and a half after she died, so

42 43 Part three: Other information Part three: Other information

3.7 Donna Lovie, Assistant Practitioner at Sue Ryder 3.8 Quality driven by research Neurological Care Centre Dee View Court (case study) Why do we need research? Donna Lovie is an Assistant Practitioner at Sue Ryder Neurological Care Our research activity aims to support discovery and We are working collectively within the organisation to Centre Dee View Court, and was recently presented with a Cavell Star Award. implementation of the best possible care for our embed an inclusive, well informed research culture patients and service users. It helps us determine that creates enthusiastic, research-aware staff, She has played a key role in running to enjoy, such as the art, and great to see which interventions and care models are best volunteers and service users that ultimately turns Sue Ryder Dee View Court’s ‘5Rs’ (Relax, people’s confidence grow over the weeks.” clinically and which are most cost effective. It research from ‘something that is done’ into ‘something Reintegrate, Re-energise, Rebuild and Donna’s role also includes supporting new also gives us the evidence we need to support that we do’. Research working groups within palliative Regenerate) group for members of the local members of staff and delivering staff training necessary change. and neurological care are taking shape and are community who have had a stroke or been but she said her favourite part of the job is creating forums for generating research ideas, sharing diagnosed with Multiple Sclerosis. spending time with the clients and helping As an established and respected provider of excellence knowledge and expertise and championing research as them to realise their potential. “We deliver real in palliative, neurological and bereavement care and a core activity across Sue Ryder. “It was a great project. There were 10 person-centred care so everybody gets the support, Sue Ryder continues in its ambition to become members of the group altogether and care that they want and need.” an influential member of these research communities. The Research Lead, along with a Research Governance the project ran for 10 weeks offering lots We have made strides in achieving this through Group made up of representatives from across Sue of different therapies such as shiatsu and The Cavell Star Awards are run by the Cavell actively seeking and establishing mutually supportive Ryder, provides expert oversight of all research activity aromatherapy. We also ran activities such Nurses’ Trust and recognise nurses, midwives, partnerships with our research peers, including within Sue Ryder. This ensures that our research as art and yoga sessions and talks on things nursing associates and healthcare assistants universities and other academic institutions, the governance is robust and meets the necessary legal, like fatigue management. It was nice helping who show exceptional care to patients, patients’ NHS, other hospices, fellow charities and the National ethical and regulatory requirements that safeguard the people to rediscover interests that they used families and their colleagues. Donna said: Institute of Health Research Clinical Research Networks rights, dignity and wellbeing of all research participants. (NIHR CRNs). We also participate in nationwide palliative care research stakeholder consultations and have I didn’t know anything about it until I formally joined the NIHR Consortium. got the award so it was quite a shock! I’ve never thought of the work I do as exceptional. As far as I’m concerned, I have the best, most rewarding job you could ask for and it’s the clients and my colleagues at Sue Ryder Dee View Court who make me so passionate and want to get out of bed and go to work in the morning.

44 45 Annexe 1: Commissioner feedback Annexe 1: Commissioner feedback

Annexe 1: Commissioner feedback

Every year we share our draft national Quality Account with our service users and the The CCG feel that you have a well stated vision, mission To improve a safe team working culture and reduce local Clinical Commissioning Groups for all our services asking for their feedback and and values. Of particular note is the inclusion of staff harm to residents it is encouraging to read links have areas for improvement. We would like to share their feedback with you. feedback in the redesign of the corporate values. been established with the University of Leeds, Leeds The ‘Our Services Map’ highlights the palliative, Teaching Hospitals Trust and the Bradford Institute for Oxfordshire Clinical I’m also always impressed to see workforce planning neurological and bereavement services which reach Health Research. Equally encouraging is Sue Ryder’s Commissioning Group and staff training being prioritised, as in palliative care the wider community and enable greater numbers to continued ambition to become an influential member I truly believe our staff are our greatest asset, and their access the quality of care they deserve. of the research community. We agree with the priority areas for the coming year. passion and caring attitude, are what we build patient We have reviewed the Quality Account and noted the experience around. The quality account acknowledges different The CCG looks forward to reading next year’s quality great levels of satisfaction for families using the service approaches have been adopted by Sue Ryder in account on how the implementation of the ‘Huddle Up and the excellent CQC ratings achieved across all Sue Our response to the feedback received: responding to Covid-19. One approach is the use of for Safer Healthcare’ (HUSH) has progressed across all Ryder Hospices. We value Sue Ryder’s efforts and Thank you for your feedback on our National Quality technology so families can stay connected with their sites including Wheatfields. contribution to end of life services in Oxfordshire and Account 2019–20. In this coming year we will be loved one. look forward to continuing to work with Sue Ryder. implementing our updated service user participation Following the appointment of the new Chief Medical strategy to all our services which focuses on service The CCG note the number of incidents resulting in Director, who aims to disseminate learning from Our response to the feedback received: user engagement and experience to drive quality severe harm identified on page 31 have increased since national audits across the organisation, it will be Thank you for your feedback on our National Quality improvement initiatives to deliver the highest quality 2018–2019. We feel this table could be enhanced by welcomed to understand what learning has been Account 2019–20 – we really appreciate you taking and harm free care. Workforce planning and staff identifying themes and incidental learning from the implemented to improve service user care and the time to get back to us. It is very important to Sue training are critical priorities for us in the coming year investigation process. Furthermore, it would be useful experience across all sites including Wheatfields. Ryder that we seek timely and regular feedback from which will be shaped and embedded by staff working to see some comparative benchmarking data with our service users and their families to enable us to in all our centres. We look forward to continuing to other hospices, should it be available. 2020–21 priorities and patients/staff stories continue to improve the specialist care and services we work with you in the coming year and appreciate you It is acknowledged that your priorities reflect provide. We are very proud of our excellent CQC ratings taking the time to get back to us. Engagement is reflected throughout the document commitment towards listening to patients and using achieved this year by our Palliative and Neurological and Sue Ryder clearly sees the value in engaging with feedback to enhance the service offered, whilst centres and look forward to continuing to work with Leeds Clinical patients, carers, the wider public and staff (pages 37– delivering a safe and compassionate service. The you in the coming year. Commissioning Group 44). Of note is the introduction of the ‘You Said We Did’ priorities presented within the quality account indicate boards. It will be interesting to read next year how the improvement underpinned by real life stories. Bradford Clinical Jo Harding, Executive Director of Nursing and Quality real time feedback survey has progressed. Commissioning Group We would like to thank you for giving Leeds Clinical Priority 1: Service user safety Commissioning Group (CCG) the opportunity to Sue Ryder has been responsive in understanding the The CCG are supportive of your approach to ensure Justine Joy, Head of Strategy, Change and Delivery review and comment on your quality account and gaps in its staff knowledge relevant to mental health service users are kept free from harm with this year’s I love the style of this report, with the priorities, followed reflect on your achievements for 2019–20 and and dementia. This new understanding can only prove focus on reducing the incidence of falls. As has been by the ‘we did’ sections and the case study examples – priorities for 2020–21. We continue to work in to be beneficial to the care of service users. highlighted earlier it will be of interesting reading shows real commitment to improving and maintaining partnership with Wheatfields Hospice and recognise to understand the impact on reducing falls with the quality standards, listening to service users and staff your open, transparent and engaging approach 2020–21 priorities and quality indicators. introduction of the HUSH model. and acting upon what they say is important to them. to delivering excellent palliative, neurological and The CCG is encouraged to read the priorities for bereavement support. 2020–21 are based on the themes of clinical incidents, Priority 2: Clinical effectiveness I love the priority given to service user engagement concerns, service user feedback and consultation with With the implementation of rehabilitation models and experience, as we can learn so much from every Overall, we feel the quality account is well laid out, easy staff from across the Sue Ryder organisation. of care the CCG is encouraged that service users in journey through the doors. to read and aided by the use of pictures, graphics and your neurological care centre are able to maximise testimonials from patients, relatives and staff.

46 47 Annexe 1: Commissioner feedback Annexe 1: Commissioner feedback

Annexe 1: Commissioner feedback (continued)

their potential and maintain greater independence. Our response to the feedback received: However, it may be that there is more of a focus over Our response to the feedback received: However, the quality account does not highlight which Thank you for your detailed feedback on our National the next year on BAME communities, in terms of Thank you for your feedback on our National Quality models of care will be used. Therefore, for the 2021–22 Quality Account 2019–20. In response, we have now access to services and potentially responsiveness to Account 2019–20 – we really appreciate you taking quality account it will be beneficial to reference which included in the final National Quality Account 2019–20 needs and cultural sensitivity, aftercare and support. the time to get back to us. We would really want to models of care will be used. the key themes and learning from incidents that have We are also keen on delivering citywide themes based work with you further on how to improve access caused harm. We have been working with Hospice UK on what people are telling us around inequalities, to our services for BAME communities and people Priority 3: Service user and staff safety as part of their National Patient Safety Programme, people’s voice and kindness and compassion. It would experiencing inequality. Our Hospice Director at Unlike the previous year the quality account states regarding harm-free care. This allows us to compare be good if we could work with you to ensure these are Wheatfields will contact you to progress this. Sue Ryder have undertaken a number of audits clinical incidents with other hospices and assess our incorporated into next year’s quality account. across the portfolio. Given the ongoing pandemic it performance against this national benchmarking for is encouraging to read the infection prevention and in-patient hospice care. The results of which we will control audits will be revised and increased to ensure include in next year’s account. It will also allow us to safe practice to prevent the spread of Covid-19. Again, recognise where we can continue to improve the safe reading the outcomes of these audits and how they and high quality care for our patients. improved patient’s safety will make interesting reading. We have already seen excellent results from the pilots Priority 4: Service user experience of the Huddle up for Safer Healthcare in the reduction The CCG look forward to reading a summary of of falls, with one hospice achieving over 50 days available findings from the impact on service user’s without a patient having a fall. At our neurological participation in the Physical Activity in Palliative and centres who provide rehabilitation we have achieved Neurological Care Clinical Practice study in the quality great outcomes for our clients and will discuss in more account for 2020–21. The CCG are pleased to read the detail the models of care in next year’s Quality Account. quality account is available in alternative formats on We have placed under “More Information about Sue request. It is recommended this information is placed Ryder” the request for the Quality Account to be underneath ‘For More Information about Sue Ryder’ available in different formats. followed by the London address. Your Healthwatch Leeds We acknowledge that the quality accounts are reported from a national perspective for Sue Ryder We found the Sue Ryder Quality Account easy and even though Wheatfields is the local hospice upon clear to read and believe it tells a story of progress that which Leeds CCG is able to comment. However, is measured. it would have been beneficial to have insight into specific clinical outcomes for Wheatfields, The priorities for the coming year seem appropriate, benchmarking data and identified lessons learnt that are measurable and will deliver outcomes that will underpin the 2020–21 priorities to help provide a support the organisation on its journey of continuous rounded local system perspective. quality improvement.

Once again, we would like to thank you for sharing the Over the last year we have worked with Wheatfields document and providing an opportunity to comment Hospice in Leeds as part of the Palliative Care Network on your quality account and priorities for 2020–21. to gather feedback on end of life care. The comments we received about Wheatfields during the Bereaved Carers survey were overwhelmingly positive, which was pleasing to see.

48 49 Annexe 3: Final Statement Annexe 2: Final statement

Annexe 2: Final statement

Sue Ryder are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations to prepare Quality Accounts for each financial year. In preparing the Quality Account, we are required to take steps to satisfy ourselves that:

• The content of the Quality Account meets the • The data underpinning the measures of requirements set out in the NHS Improvement and performance reported in the Quality Account is supporting guidance 2018–19 robust and reliable, conforms to specified data quality standards and prescribed definitions, is • The content of the Quality Account is not subject to appropriate scrutiny and review inconsistent with internal and external sources of information including: – relevant committee • The Quality Account has been prepared in minutes and papers for the period April 2019 to accordance with the Quality Accounts regulations. March 2020 – papers relating to quality reported over the period April 2019 to March 2020 – The Quality Account was approved by Trustees at feedback from commissioners the Health and Social Care Sub-Committee on 24 June 2020. • The Quality Account presents a balanced picture of Sue Ryder’s performance over the period covered

• The performance information reported in the Quality Account is reliable and accurate Neil Goulden Heidi Travis • There are proper internal controls over the Chairman of Trustees Chief Executive collection and reporting of the measures of 24/06/2020 24/06/2020 performance included in the Quality Account, and these controls are subject to review to confirm that they are working effectively in practice

50 51

There when it matters

Sue Ryder supports people through the most difficult times of their lives. For over 65 years our doctors, nurses and carers have given people the compassion and expert care they need to help them live the best life they possibly can.

We take the time to understand what’s important to people and give them choice and control over their care. This might be providing care for someone at the end of their life, in our hospices or at home. Or helping someone manage their grief when they’ve lost a loved one. Or providing specialist care, rehabilitation or support to someone with a neurological condition.

We want to provide more care for more people when it really matters. We see a future where our palliative and neurological care reaches more communities; where we can help more people begin to cope with bereavement; and where everyone can access the quality of care they deserve.

For more information about Sue Ryder call: 0808 164 4572 email: [email protected] visit: www.sueryder.org

/SueRyderNational @sue_ryder

Sue Ryder, 183 Eversholt Street, London NW1 1BU

This document is available in alternative formats on request.

Sue Ryder is a charity registered in England and Wales (1052076) and in Scotland (SC039578). Ref. 07195. © Sue Ryder. October 2020.