Quality Account 2010/11 Our quality performance, initiatives and priorities Contents

Who we are and what we do, plus commendations 1 Part 1 – Our priorities for quality Joint statement from the Chair of Trustees and Chief Executive Officer 3 Part 2 – Our priorities for improvement Overview 4 – Priority 1 Service user experience 5 – Priority 2 Effectiveness, safety and service user experience 6 – Priority 3 Service user safety – reporting 8 – Priority 4 Service user safety – falls 9 Part 3 – New initiatives for 2011/2012 – Priority 1 Service user experience 10 – Priority 2 Service user safety and effectiveness 11 – Priority 3 Effectiveness 12 – Priority 4 Service user safety – reporting 13 – Priority 5 Service user eating experience and nutrition 14 Part 4 – Indicators – Service user experience 15 – Safety 18 – Effectiveness 20 Part 5 – Annexes Annex 1 Essential information 23 Annex 2 Statements from commissioning Primary Care Trusts (PCTs), 24 Overview and Scrutiny Committee (OSC), the Sue Ryder National Service User Advisory Group ‘Acorns’ and Local Involvement Networks (LINks) Who we are and what we do Sue Ryder provides compassionate care for people living with life-limiting and long-term conditions. We are a national charity that delivers health and social care services to local communities in a number of ways.

As well as day care, respite care, homecare, hospice and hospice-at-home services and long-term residential care, we also work in partnership -with sheltered housing projects and help with community integration.

This Quality Account sets out our commitment to improving quality across all of our services. But to start with, here are a few commendations taken from our service user survey.

“This was the ideal stepping stone from hospital to coming home for his last days with us.” A relative of a hospice inpatient

“I have space to be my own person, or I can choose to be as involved as I want to be. This is important to me.” A resident at one of our neurological care centres

“All carers are very helpful and kind and the care I’ve received is first class.” A service user receiving homecare

1 2 Sue Ryder – Quality Account 20 10/11 Part 1 Our priorities for quality

Joint statement from the Chief Executive and which is now called the Senior Leadership Team (SLT). This is the Chairman set to improve the monitoring of performance relating to quality systems and processes, compliance with Sue Ryder Welcome to our second annual Quality Account – a summary policy and national standards. of our performance against selected quality measures for 2010/11 and our initiatives and priorities for quality This Quality Account demonstrates the progress that has improvement in 2011/12. been made in relation to identified quality initiatives and sets a further ambitious programme of quality improvement Sue Ryder is a national health and social care charity which projects for the forthcoming year. The Quality Account also provides specialist palliative care, neurological and homecare provides an honest representation of progress made during to people living with conditions such as cancer, dementia, the year, and in partnership with users of our services, it Parkinson’s disease, Huntington’s disease and other outlines where further improvements are needed. And finally, complex conditions. it celebrates the good outcomes reported by service users and commits us to learning from reported experiences where This Quality Account is produced to inform service users outcomes did not meet with expectations. (current and prospective), their families, our staff, our supporters, commissioners and the public. The contents have been influenced and have the endorsement of our national Service User Advisory Group known as Acorns.

Progress has continued since the publication of our first Quality Account in June 2010. Since the appointment of a new Director of Health and Social Care, there has been a Paul Woodward Roger Paffard re-organisation of the Senior Management Team (SMT), Chief Executive Chairman

Sue Ryder – Quality Account 20 10/11 3 Part 2 Our priorities for improvement

Overview The priorities for 2011/2012 are summarised below. Priorities for 2011/12 have been influenced by service user experience and involvement, national standards and learning Priority 1 from enhanced quality performance data. Service user experience To work towards a personalised approach to service Over the course of the last year a number of projects have delivery and care culminated in improved information relating to user experience, incidents, complaints and compliance with Sue Priority 2 Ryder policies and procedures. This, alongside national policy, Service user safety and effectiveness has helped to influence our priorities for 2011/12. To manage the risk of harm from pressure ulcer development

The priorities detailed below do not represent all that Priority 3 Sue Ryder is doing to improve a person’s experience of our Effectiveness services but they give an indication of particular areas of focus. To support the development of our clinical leaders

Our quality strategy focuses on the same three key areas that Priority 4 were identified in the previous Quality Account: Service user safety and effectiveness effectiveness To further develop a culture of learning from incidents service user safety and complaints service user experience Priority 5 Service user experience, safety and effectiveness To improve the eating experience and meet the nutrition needs of the people in our care

These priorities have been approved by Acorns (our national Service User Advisory Group), the Executive Leadership Team (ELT) and our Board of Trustees.

4 Sue Ryder – Quality Account 20 10/11 Priority 1 Service user experience

Initiatives We have completed a review of our Bixley Road service in Management of complaints Ipswich, where four tenants live in a housing association We said that we would improve how we manage bungalow with 24-hour care supplied by us. This service has complaints by recording and learning from issues and now been open for three years. It has been reviewed during trends raised through complaints. March 2011 using an assessment tool that has been adapted for use in neurological care from the national standards used During 2010/2011 we have introduced a new procedure, in for learning disability services. The review incorporated line with new regulations, for listening and responding to feedback from focus interviews with service users and from complaints in health and social care. We set up a system for commissioners of care. This process was led by one of our recording all formal complaints on a charity-wide database. operational managers and identified the areas where the This has made it possible for us to see trends and share tenants were confident and happy with their home and care learning between services in different locations. We have support. It also identified further improvements that can be provided training for staff to help all staff understand their implemented to encourage greater decision-making and responsibilities to listen and act on complaints and to improve management opportunities for the tenants themselves. investigation and management of complaints. This work will influence our supported living project work over User involvement the new few years. We said that we would work with the Service User Advisory Group to promote the importance of every person being treated as an individual, and what this might mean for people using our service.

During 2010/2011 we have supported the new Service User Advisory Group to hold three meetings, including one with the Chair of Trustees sharing ideas on how we can grow involvement and understanding between service users and Council. The group, attended by between 12 and 17 service users in three locations, has identified their priorities, agreed terms of reference, and chosen a new name. Now known as Acorns, from the saying ‘great oaks from little acorns grow’, the name reflects their aspiration that from small beginnings the group will continue to grow in stature and influence. Their key achievements during 2010/2011 have been:

• helping in the appointment of a new Director of Health and Social Care in 2010 • commenting on our new Health and Social Care Strategy • sharing experience from local services and raising issues such as how we support staff, and the comfort and safety of hoists • initiating a project for service users to interview other service users about the importance of being treated as an individual.

Sue Ryder – Quality Account 20 10/11 5 Priority 2 Effectiveness, safety and service user experience

To improve our quality ratings at inspections inspections during the course of the year, but where they did Our services are inspected by two regulatory bodies: take place, there was an improvement or no decline in the • Care Quality Commission (England) inspection rating, as the following table demonstrates. • Social Care and Social Work Improvement Scotland (SCSWIS) Summary of quality ratings for our services The different services are currently inspected against a set of Our hospices have not been included within this table as Essential Standards of Quality and Safety (England) and Care although they are inspected by the Care Quality Commission, Standards (Scotland). they have not received an overall rating since July 2010. This is when the rating of services by the Care Quality Commission During 2010/2011 we aimed to improve our inspection (as the regulator for health and social care) ceased. ratings to be rated good or above. There have been few

Service Date of Inspection Current Rating Previous rating Direction of travel (at March 2011) since last inspection

Adult Care – England Holme Hall August 09 Good  Good  Standards (Aug 07) maintained Cuerden Nov 09 Good  Adequate  Improvement (Sept 08) Stagenhoe March 2010 Excellent  Excellent  Standards (April 07) maintained The Chantry May 10 Excellent  Excellent  Standards (June 09) maintained Hickleton April 10 Good  Good  Standards (Aug 07) maintained Adult Care – Scotland Dee View Nov 10 Excellent Excellent Standards (June 10) maintained Care of the Elderly – England Birchley Feb 2010 Excellent  Excellent Standards (annual service review) (Dec 07) maintained Domiciliary Care – England Wigan (St Helen’s) Dec 09 Good  Good Standards (Dec 07) maintained Lincoln March 10 08 Excellent  Excellent Standards (Dec 08) maintained Macclesfield Jan 2010 Good  Adequate Improvement (Dec 08) Wolverhampton Jan 2010 Good  Good Standards (annual service review) (Nov 08) maintained Sale (Trafford) April 10 Good  Adequate Improvement (April 00) Doncaster/Barnsley/Rotherham March 10 Good  Good  Standards (annual service review) (Feb 09) maintained Bixley Rd Ipswich (Independent Living) Aug 08 Good  August 08 Newark Not yet rated was the first NA Bournemouth Not yet rated inspection Domiciliary Care – Scotland Arbroath Jan 11 Good Primarily adequate and Good (Feb 10) Improvement

6 Sue Ryder – Quality Account 20 10/11 Initiatives The homecare survey tool has been refined and is now We said that we would carry out a further review of the reported centrally to enable monitoring of outcomes by quality visit process for our hospices and neurological care managers and to support the setting of priorities and centres, based on regulatory requirements. service-based Quality Improvement Plans.

During 2010/2011 we have reviewed the quality visit process Four services have been targeted with the aim of establishing for all services against the Care Quality Commission (CQC) service user forums and community networks (for example Essential Standards of Quality and Safety (services in England) Age Concern and LINks). and the National Care Standards (Regulation of Care (Scotland) 2001). More recently a review of the management Arbroath – The first forum was held in November and service structure at senior level has seen both the Quality Team and users appreciated the opportunity to be involved close to Regional Managers carrying out Quality Inspection Visits, home. They suggested meetings should be held twice a year some of which have been themed (for example Falls Risk and and said they will be watching closely to see how their Moving and Handling policy compliance) and some take suggestions are taken up. account of all regulatory standards and outcomes for service users using the CQC Provider Compliance Assessment tools. Bournemouth – A meeting was held with the local LINk in September 2010 with a view to working together on issues We said that we would introduce a revised quality visit including personalisation. Since then their first forum meeting process within Domiciliary Care Services. was held on 23 March 2011. The meeting was informal with an opportunity for service users who attended to meet with During 2010/2011 we have revised the quality visit template staff and talk about their lives. for use in inspecting the Sue Ryder Homecare Services both in England and in Scotland in line with Essential Standards Heyeswood – The model of care at Heyeswood is different (England) and Care Standards (Scotland). This template has from other domiciliary services. Here we provide care and been used to inspect services and to inform the quality support, as well as recreational activities, to tenants in their improvement plan within each service own retirement homes. The residents hold ‘street meetings’ once a month and one of our local managers is invited. In this We said that we would continue quarterly reporting way we receive first-hand insight into the issues and concerns of inspection findings to the Healthcare Governance of residents. This contributes to the Activities Plan and the Committee and Integrated Governance Committee, Quality Improvement Plan. A new volunteer scheme has with actions taken in response to inspection and recently started and this also responds to needs identified by organisational learning. residents. Befriending and organised walks are two ideas that have been suggested so far. During 2010/2011 a report has been tabled at each of the quarterly Committee Meetings outlined above and assurance Sue Ryder has become a member of the local LINk in given of actions taken in response. St Helen’s and will be taking part in their Dignity and Care project. We said that we would increase operational support to Care Managers in Homecare to support quality Trafford – development here has been slow due to other improvement initiatives work pressures however dedicated resource has now been allocated to support the manager to set up the local forum. During 2010/2011 the Quality Team have each supported a The first meeting took place in May 2011. number of homecare services by carrying out Quality Inspection Visits and attending Quality Improvement Group Wolverhampton – Although not one of the areas identified for Meetings. More recently a Social Care Forum has been set up development, the first service user forum at Wolverhampton to encourage the sharing of best practice and to promote was held on 17 February 2011. Those service users spoke quality improvement initiatives. about the things they value about the service such as seeing the same carers regularly and receiving a helpful response Complaints training has been delivered to all Care Managers from the office if there are any problems. They also mentioned and also to Care Organisers in the larger services. Incident areas for improvement: they would like carers to be able to reporting training and audit training has been delivered to spend more time talking to them and to turn up on time. managers in addition to training to support the use of the electronic incident reporting tool.

Sue Ryder – Quality Account 20 10/11 7 Priority 3 Service user safety – reporting

To introduce an electronic incident reporting system Initiatives The way in which an organisation manages risk is a key We said that we would further refine the Datix tool based indicator of its competence. Managing risk, as in the on feedback from services and learning from the process identification and effective treatment of risk and learning of producing reports. from adverse events, protects those who receive care, our staff and our assets. It also improves performance and During 2010/2011 we have identified configuration changes reputation, and helps to reduce financial loss. We set out our that will be needed when we apply the latest version of Datix. proposal to introduce a more reliable system of monitoring Work has been carried out within the Professional Forum incidents in our Risk Management Strategy for 2008-2011. (a meeting of the Heads of Care) to encourage improvements in the categorising of incidents so that monitoring of trends We have now introduced an electronic risk management can be facilitated. tool (Datix) that is compatible with the current Sue Ryder computer system and that meets the requirements of We said that we would mo ve over to use of the latest version incident reporting (including health and safety incidents of Datix that has greater functionality but does not change and service user safety incidents) the process of reporting for front-line staff.

During 2010/2011 we have not been able to introduce the latest version of Datix however this is planned in support of working towards the Complaints Module. The functionality of the current Datix version has not impaired the reporting of incidents over the course of the year.

We said that we would build a portfolio of reports to inform the Senior Leadership Team (SLT), and we said that we would use information to further develop the Health and Social Care Directorate Risk Register.

During 2010/2011 we have presented a quarterly report to the Healthcare Governance Committee and Integrated Governance Committee. A regular agenda item has been introduced into the monthly Senior Leadership Team (SLT) meetings where the learning from serious incidents is discussed. This team owns the Health and Social Care Risk Register and therefore the Risk Register is updated in response.

We said that we would aim to use the Complaints Module within Datix to improve monitoring and learning from complaints.

During 2010/2011 we have prepared a project plan and started by undertaking a process-mapping exercise to examine the process involved when a formal complaint is received. This is essential preparatory work before starting to use the Datix Complaints Module. The target date for introduction of the system is July 2011, and training will be rolled out during August and September.

8 Sue Ryder – Quality Account 20 10/11 Priority 4 Service user safety – falls

To reduce the harm from falls Initiatives Falls are known to be the most reported safety incident We said that we would complete and distribute a falls nationally and many falls result in harm to the person who prevention leaflet for people in receipt of care and is receiving care. There will always be a risk of falls within their families. health and social care services given the nature of the people we care for. However, there is much that can be done to During 2010/2011 we completed this falls prevention leaflet, reduce the risk of falling and to minimise harm, while at the which is now in use in all services. same time enabling service users to be independent and as mobile as possible. We said that we would monitor the number of falls, and factors associated with falls, more closely in conjunction An initiative started in 2009 was continued during 2010/20 11 with the introduction of electronic incident reporting. with the aim of managing the risk from falls as far as possible without impeding a service user’s right to independence and During 2010/2011 the use of the Datix electronic incident choice. The Clinical Quality Team has worked alongside the reporting system has been embedded in all services and Health and Safety Team to take forward the following a quarterly report to the Healthcare Governance Committee 2010/2011 initiatives. incorporates information relating to falls involving service users.

We said that we would audit compliance with the falls risk management policy across services.

The Falls Risk Management Policy incorporates a number of tools to support the assessment and management of the risk of falls. There is a requirement for falls risk training and a training package and lesson plan has been produced to support this. During 2010/2011 we introduced a falls audit into the annual core audit programme that has helped us to monitor compliance against the policy and to ensure that actions are put in place where the policy requirements were not being met. Particular issues that arose related to the delivery of training because of Education Lead vacancies. Progress is starting to be made now that these vacancies have been filled. More recently a ‘Falls and Moving and Handling themed quality visit’ has been developed for use by operational regional managers to further assess compliance against policy.

Sue Ryder – Quality Account 20 10/11 9 Part 3 – New initiatives for 2011/2012 Priority 1 Service user experience

Service user experience Executive Leadership Team (ELT) sponsor During 2011/2012 we would like to give our service users Steve Jenkin, Director of Health and Social Care greater choice and control over the care that they receive so that they consistently report to us that they feel treated as an Implementation Lead individual. During the course of the year we are going to Sue Hogston, Head of Clinical Quality and Nurse Lead cascade and capitalise training throughout the Health and Social Care Directorate to introduce a more person-centred Programme Manager way of care planning, To achieve this we have engaged Angela Killip, Quality Manager experts via Helen Sanderson Associates and Groundswell who will help us to:

• train staff within all centres • design a new person-centred care planning tool and test this in the three pilot sites • integrate into the person-centred care planning approach the feedback that Acorns gives us with regard to what it feels like to be treated as an individual • scope the work that is needed to change our policies and reflect our aim of becoming a more person-centred organisation • evaluate the success of the pilot project • work towards a personalised approach to service delivery through continued working with our service users.

Acorns, our national Service User Advisory Group, was formed in November 2009. They quickly identified their two priorities were: • to reach out to include the views of as many service users as possible • to promote the importance of being treated as an individual.

A project that will see service users interviewing other service users embraces both these priorities. The project will be led by Acorns and promote the positive achievements of Sue Ryder to deliver person-centred care. Once interviews have been conducted, the voice of service users talking about what is important to them will be presented for internal and external audiences.

Recruitment of service users to the project and training in interview skills has commenced. The project is projected to be delivered by October 2011.

10 Sue Ryder – Quality Account 20 10/11 Priority 2 Service user safety and effectiveness

To manage the risk of harm from pressure Executive Leadership Team (ELT) sponsor ulcer development Steve Jenkin, Director of Health and Social Care Pressure ulcer damage and prevention of avoidable harm from pressure ulcers (known by some as bed sores) has been Implementation Lead identified via incident reporting as an area of practice that is Sue Hogston, Head of Clinical Quality and Nurse Lead reported variably. We want to ensure that our staff are skilled and equipped with the right tools to identify those who are at Programme Manager risk of pressure area damage and that the right equipment is Lesley Bates Quality Manager available to support the management of risk.

During 2011/2012 we will minimise inconsistency in care provision by providing all services with a Pressure Ulcer Prevention and Treatment policy to highlight the best evidence and advice available to us. We will access the National Institute of Clinical Evidence and the leading European Pressure Ulcer Advisory Committee for guidance and teaching resources. To complement the policy we will:

• produce a service user information leaflet which includes pressure ulcer prevention and management for service users and their families/main carers • develop and review supporting teaching aids and links to web resources • standardise our approach to risk assessment and ensure that health and social care records reflect the level of risk for pressure ulcer development • ensure that all people admitted to one of our care centres or hospices are screened for risk of pressure ulcer damage and that care plans are developed to address each risk factor • review the existing record keeping audit tool relating to the assessment and prevention of pressure ulcers in line with the new policy and integrate this into our core clinical audit programme • continually monitor the incidence of pressure ulcers at grade 2 and above acquired when patients are not in our care or when they are receiving care from us • incorporate into the serious incident policy the requirement to report grade 3 pressure ulcers and above • ensure that details of learning associated with the investigation of grade 3 and above pressure ulcers will be shared across professional forums • present a monitoring report to the Health and Social Care Governance Committee at least twice a year • identify an organisational lead for pressure ulcer prevention and management who will facilitate the sharing of best practice with service based named leads.

Sue Ryder – Quality Account 20 10/11 11 Priority 3 Effectiveness

To support the development of our clinical leaders Executive Leadership Team (ELT) sponsor within a range of clinical environments Steve Jenkin, Director of Health and Social Care We recognise that clinical leadership is fundamental to delivering high quality, clinically effective and safe care for Implementation Lead our service users. Sue Hogston, Head of Clinical Quality and Nurse Lead

Under licence from the Royal College of Nursing (RCN), the Programme Manager/Local Facilitator RCN Clinical first cohort of 13 front-line clinical leaders, from specialist Leadership Programme palliative care and neurological care settings commenced Jane Appleton, Quality and Learning Manager the leadership programme.

This year-long programme involves workshops and action learning groups to develop the leadership skills and knowledge of clinical leaders to enhance the quality of the services delivered to our service users. Module workshops include the culture of the organisation, self-development as a leader, quality and safety and team-working. Sue Ryder is believed to be one of the first voluntary sector organisations to invest in this well established and positively evaluated programme.

As part of the programme the participants will each complete a local service improvement initiative.

A Sue Ryder Learning and Education Lead has attended the RCN clinical leadership facilitators’ programme and is supported by the RCN to implement the programme.

During 2011/2012 Sue Ryder will: • present the Service Improvement Projects at a conference day in January 2012 and will share the learning from these projects across the whole organisation • recruit to the second cohort of the clinical leadership programme, commencing the programme in January 2012 • evaluate the programme and seek to identify the differences the programme has made, particularly to service user experiences • use the programme to develop the expertise of our clinical leaders to share local quality improvements and good practice across the whole organisation to enhance the experience of our service users.

12 Sue Ryder – Quality Account 20 10/11 Priority 4 Service user safety – reporting

To further develop a culture of learning from We want to improve the way that we learn from the incidents and complaints complaints that we receive and apply the learning across the organisation. This will partly be achieved by improving our We would like to continue to develop a culture of learning personalised approach to care (New Initiatives Priority 1) and from all incidents and complaints, particularly those of a through our investment in the clinical leadership programme serious consequence to those who use our services. So we (New Initiatives Priority 3). have started to develop a serious incident strategy that sets out a staged process for enabling and promoting learning During 2011/2012 we will: from incidents and the Serious Untoward Incident Policy is • incorporate into a new risk strategy actions that will improve under review. the way that the organisation learns from serious incidents • revise the current serious incident policy and introduce this Complaints are currently recorded within each service using a across all services following consultation with staff complaints monitoring form and information is sent to the • refine the use of the Datix incident reporting tool to ensure Service User Involvement Lead for inputting into a database that the best possible quality of information about incidents and then reported through to the Healthcare Governance is available to managers so that they can learn from and take Committee and the Integrated Governance Sub-Committee action to prevent incidents of a similar nature in the future of the Council of Trustees. This process does not facilitate the • share learning from incidents via the development of learning process across the organisation, is labour intensive Learning for Patient Safety memos across the organisation and does not guarantee that all data is collected. We intend to • further develop the Health and Social Care Risk Register move towards an electronic complaints reporting process of and associate Risk Plan the kind implemented for incident reporting. • introduce use of the web-based Datix Complaints Module. This will enable more accurate monitoring of complaints Key themes from complaints: reported, learning, actions taken and response times. Hospices Complaints leads will be trained within each service to use There are low numbers of complaints in hospices (just 10 the system and quarterly reports will then be reported to over all sites, the same number as 2009/10) with more than the Health and Social Care Governance Committee from half being concerned with communication. These complaints 2012 onwards. included speaking to other professionals about a case when the complainant thought this was inappropriate, and a conversation about prognosis being upsetting. Other Executive Leadership Team (ELT) sponsor complaints were about quality of care, medication and Steve Jenkin, Director of Health and Social Care staffing levels. Implementation Lead Care centres Sue Hogston, Head of Clinical Quality and Nurse Lead There are also a low number of complaints in care centres (7 over all sites, compared with 10 in 2009/10) including one Programme Manager on the environment, and others concerning communication Helen Press, Quality manager with residents or their families.

Homecare There is no comparable data from 2009/10, but 104 complaints were received in 2010/11, the top issues being missed calls (23), quality of care (20) and staff attitude (15). Other issues that appear regularly are communication, problems supporting people with their medication and the timing of calls not being appropriate. Those complaints made about the quality of care often refer to a number of problems combined leading to poor outcomes for the client, care not being carried out in accordance with the care plan, or failing to meet the expectations of the client or their family in terms of the level of service or the way tasks are done.

Sue Ryder – Quality Account 20 10/11 13 Priority 5 Service user eating experience and nutrition

To improve the eating experience and the nutrition of During 2011/2012 we will: the people in our care • work with our service users and staff to improve the Our service users have told us that they would like us to mealtime experience by setting a standards and improve the eating experience and would like to work with monitoring achievement of that standard us to do so. This has been reported within our annual survey, • ensure that service users are enabled to influence by our national Service User Advisory Group (Acorns) and menu options and make choices about what they eat by a number of our local service user involvement groups. and when they eat • review the existing Nutrition and Hydration Policy to ensure We recognise the importance of ensuring that the people that it is in line with best practice and to ensure that it we care for are supported to have adequate nutrition and supports the standard set by our service users and staff hydration regardless of whether they are able to eat • provide greater support to the staff who carry out the independently, need support to eat, where supplements nutritional assessment that is appropriate to the care are prescribed or where a person cannot take food and environment drinks by mouth. • review catering standards across the organisation.

We recognise the social importance of mealtimes and we Executive Leadership Team (ELT) sponsor want to take advice from our service users so that we can Steve Jenkin, Director of Health and Social Care improve that experience. We also want to be sure that all staff involved in preparation of meals, or involved in supporting Implementation Lead people to eat, understand what constitutes a balanced diet. Sue Hogston, Head of Clinical Quality and Nurse Lead

We know that some of the people who use our services are at Programme Manager risk because of complex nutritional issues such as malnutrition, Helen Press, Quality Manager swallowing difficulties or obesity. We therefore want to ensure that our staff are skilled and equipped with the right tools Associate Programme manager to identify those who are at risk. We want our Nutrition and Martin Russell, Head of Support Services, Thorpe Hall Hospice Hydration Policy and Procedure to be clear about steps to take where our service users are identified as at risk so that advice is then sought from appropriate experts with the agreement of our service users.

We would like to ensure that assessments are made by our staff so that care plans reflect personal choice and reflect actions taken to manage any risks identified.

Sue Ryder has a Nutrition and Hydration Policy that was reviewed in March 2011 in response to a National Patient Safety Alert. There is however further work to do to align the policy to national guidelines.

14 Sue Ryder – Quality Account 20 10/11 Part 4 Indicators

1. Service User Experience – All Services

Survey and Complaints Figures

Indicator Year Neurological Palliative Homecare

Percentage of service users who rated overall care 2009/10 86% 99% 86% as ‘Good’ or ‘Excellent’ 2010/11 87% 99% 83% Percentage of service users who responded ‘Yes, 2009/10 87% 100% 97% completely’ or ‘Yes, mostly’ that overall they were 2010/11 91% 99% 94% treated with respect and dignity Percentage of service users who answer ‘Yes’ 2009/10 91% 100% Data available from 2010/11 that they would recommend the service to 2010/11 95% 100% 88% family and friends Number of formal complaints 2009/10 10 10 Data available from 2010/11 2010/11 7 10 104 Percentage of formal complaints acknow-ledged 2009/10 80% 80% Data available from 2010/11 within target timescale of 3 days 2010/11 86% 90% 66% Percentage of formal complaints responded 2009/10 80% 70% Data available from 2010/11 to in writing within target timescale of 20 day 2010/11 83% 88% 61%

Sue Ryder – Quality Account 20 10/11 15 Indicators

Service User Experience – Palliative Care Services 2010/11

Survey

Hospice Percentage of service users Percentage of service users Percentage of service who rated overall care as who responded ‘Yes, completely’ or users who answer ‘Yes’ that ‘Good’ or ‘Excellent’ ‘Yes, mostly’ that overall they were they would recommend the treated with respect and dignity service to family and friends

Leckhampton 100% 100% 100% Manorlands 99% 97% 100% Nettlebed 98% 99% 100% St Johns 99% 99% 100% Thorpe 100% 99% 99% Wheatfields 100% 100% 100%

Complaints

Hospice Number of formal Percentage of formal Percentage of formal complaints complaints acknowledged complaints responded to in writing within target timescale of 3 days within target timescale of 20 days

Leckhampton 4 75% 100% Manorlands 2 100% 100% Nettlebed 4 100% 75%

Service User Experience – Neurological Care Services 2010/11

Survey

Centre Percentage of service users Percentage of service users Percentage of service who rated overall care as who responded ‘Yes, completely’ or users who answer ‘Yes’ that ‘Good’ or ‘Excellent’ ‘Yes, mostly’ that overall they were they would recommend the treated with respect and dignity service to family and friends

Birchley 89% 95% 100% Chantry 88% 88% 91% Cuerden 83% 92% 95% Dee View 93% 93% 100% Hickleton Hall 88% 100% 88% Holme Hall 83% 82% 100% Stagenhoe 82% 91% 90%

Complaints

Centre Number of formal Percentage of formal Percentage of formal complaints complaints acknowledged complaints responded to in writing within target timescale of 3 days within target timescale of 20 days

Chantry 1 100% 100% Holme Hall 1 100% 100% Stagenhoe 5 80% 75%

The response rate to our surveys is dependent upon those who are either willing or able to complete the survey and therefore does not necessarily represent the experience of all.

16 Sue Ryder – Quality Account 20 10/11 Service User Experience – Homecare Services 2010/11

Survey

Homecare Services Percentage of service users Percentage of service users Percentage of service who rated overall care as who responded ‘Yes, completely’ or users who answer ‘Yes’ that ‘Good’ or ‘Excellent’ ‘Yes, mostly’ that overall they were they would recommend the treated with respect and dignity service to family and friends

Arbroath 91% 96% 90% Bournemouth 86% 88% 83% Manvers (Doncaster, Rotherham, Barnsley) 83% 94% 85% Heyeswood 86% 100% 100% Lincoln 72% 88% 75% Macclesfield 67% 93% 90% Newark 88% 93% 92% Rochdale 86% 100% 100% Stafford 87% 97% 91% Trafford 93% 100% 97% Wigan 95% 100% 100% Wolverhampton 86% 92% 88%

Complaints

Homecare Services Number of formal Percentage of formal Percentage of formal complaints complaints acknowledged complaints responded to in writing within target timescale of 3 days within target timescale of 20 days

Arbroath 2 100% 100% Bournemouth 3 67% 67% Manvers 52 56% 58% Lincoln 16 69% 63% Macclesfield 5 60% 40% Newark 6 100% 67% Rochdale 5 100% 100% Stafford 11 73% 45% Stirling 1 100% n/a Wigan 3 67% 100%

Complaints tables do not include the names of services where no complaints were reported centrally.

It is important to note that Manvers is our largest Homecare Service, providing around 3,000 hours of care per week. At the other extreme Bournemouth currently only provides 300 hours of care per week. Stirling is a service that has only recently been taken over by Sue Ryder and Stafford has been transferred to a new provider.

Sue Ryder would like to improve its response to complaints. However, there is recognition that future data must be provided around those more complex complaints, where an agreement has been negotiated with the complainant to extend the investigation period to ensure a satisfactory and full response. We currently are not able to demonstrate where this has occurred in the data that we collect.

Sue Ryder – Quality Account 20 10/11 17 Indicators

2. Safety

Indicator Neurological Palliative Homecare

Regulatory body inspection rating (Neurological and Homecare only) See section on Priority 2 above for details Percentage of care standards met or exceeded N/A 100% N/A by those Hospices inspected Number of incidents resulting in permanent or 0 0 0 long term harm to service users per year Number of medicines administration incidents 33 64 8 to service users per year Number of medicines prescription 0 10 1 incidents per year Number of service user slips trips and falls resulting in 6 1 8 hospital admission per year See note below Number of reports under RIDDOR 4 4 0 Please see note and table below regarding RIDDOR reports Number of Healthcare Acquired Infections and pressure ulcers acquired within our own service or acquired externally See section below

There have been no incidents that have resulted in the death, permanent or serious harm to a service user in our care during 2010/2011.

Of the 8 slips, trips or falls resulting in hospital admission in Homecare, only one fall was observed and happened when a carer was in attendance.

While the introduction of an electronic reporting system has improved data quality there is still further work to do particularly in Homecare where it is felt that the data represented above may not be fully representative of all incidents that have occurred. Due to the recent introduction and work to embed the system no comparative data is given.

Number of Reports under RIDDOR 2010/11 Number of Reports under RIDDOR 2010/11

Neurological Care Palliative Care

Centre Number of reports Hospice Number of reports

Cuerden Hall 2 Manorlands 1 Hickleton Hall 1 St Johns 2 Stagenhoe 1 Wheatfields 1 Total 4 Total 4

Two incidents reported as RIDDOR incidents (at St John’s and Cuerden) did not fit into the RIDDOR reporting criteria. It has been identified that further guidance needs to be given to staff and the Health and Safety Team are currently working on this.

18 Sue Ryder – Quality Account 20 10/11 Medicines Incidents

Medicines Administration Errors

Medicines Incidents are split by individual services below Service Total

Homecare Lincoln Homecare Service 1 Mexborough Homecare Service 1 Newark 1 St Helen's Homecare Service 4 Wolverhampton Homecare Service 1 Homecare Total 8

Neurological Care Services Birchley Hall 2 Cuerden Hall 2 Dee View Court 7 Hickleton Hall 14 The Chantry 8 Neurological Care Services Total 33

Palliative Care Services Leckhampton Court Hospice 8 Manorlands Hospice 13 Nettlebed Hospice 22 St Johns Hospice 3 Thorpe Hall Hospice 9 Wheatfields Hospice 9 Palliative Care Services Total 64

Total 105

Medicines Prescription Errors Service Total

Homecare Lincoln Homecare Service 1 Homecare Total 1

Palliative Care Services Leckhampton Court Hospice 1 Nettlebed Hospice 5 St John’s Hospice 1 Thorpe Hall Hospice 2 Wheatfields Hospice 1 Palliative Care Services Total 10

Total 11

Sue Ryder – Quality Account 20 10/11 19 Indicators

3. Effectiveness

HCAI and Pressure Ulcers The number of infections and pressure ulcers across all neurological and palliative centres reflects the period between April 2010 and March 2011. Cases are identified as those that were acquired by the service user while in our care and those acquired prior to the service user being admitted to a Sue Ryder service.

Neurological Palliative Total

Health Care Acquired Acquired Acquired Acquired Acquired Acquired Acquired Infections (HCAI) in SRC External to SRC in SRC External to SRC in SRC External to SRC

Clostridium Difficile – 2 2 6 2 8 Norovirus 19 – – – 19 0 MRSA (infection) 1 – 1 14 2 14 MRSA (colonised) – 7 – 5 0 12 ESBL (colonised) – – – 1 0 1 Hepatitis (A, B or C) – 2 – 2 0 4 Influenza – – – 1 0 1

Pressure Ulcers

Pressure Ulcers 17 6 54 225 71 231

Number of HCAI (2010/11) – Hospices and Care Centres

Health Care Acquired Infections (2010/11) l Acquired within own service l Acquired external to service

Clostridium Difficile

Norovirus

MRSA (infection)

MRSA (colonised)

ESBL (colonised)

Hepatitis (A, B or C)

Influenza

04 8 12 16 18 20 new cases

20 Sue Ryder – Quality Account 20 10/11 Number of HCAI by Service

Neurological Care

Centre Clostridium Norovirus MRSA MRSA Hepatitis Difficile (infection) (colonised) (A,B or C)

Birchley – 19 – – – Chantry – – – 5 – Cuerden – – – – – Dee View – – 1 – – Hickleton 1 – – 1 2 Holme Hall – – – – – Stagenhoe 1 – – 1 –

Number of HCAI by Service

Palliative Care

Hospice Clostridium Norovirus MRSA MRSA ESBL Hepatitis Influenza Difficile (infection) (colonised) (colonised) (A,B or C)

Leckhampton 1 – 1 1 1 1 1 Manorlands 2 – 5 2 – – – Nettlebed – – 1 2 – 1 – St John’s 3 – – – – – – Thorpe 2 – 8 – – – – Wheatfields – – – – – – –

Sue Ryder – Quality Account 20 10/11 21 Indicators

Number of Pressure Ulcers (2010/11) – Hospices and Care Centres

Pressure Ulcers (2010/11) l Acquired within own service l Acquired external to service

Neurological centres

Palliative care

0 50 100 150 200 250 300 new cases

Number of Pressure Ulcers by Service

Neurological Care Palliative Care

Centre Acquired within Acquired external Hospice Acquired within Acquired external own service to service own service to service

Birchley 2 2 Leckhampton 5 17 Chantry 6 2 Manorlands 6 20 Cuerden 2 1 Nettlebed 20 50 Dee View St Johns 7 43 Hickleton 1 0 Thorpe 1 27 Holme 3 0 Wheatfields 15 In excess of 68 Stagenhoe 3 1 Total 17 6 Total 54 225

22 Sue Ryder – Quality Account 20 10/11 Part 5 Annexes Annex 1

• During the period of this report, 1 April 2010 to 31 March led by Sue Ryder (these studies are still in progress) and 2011 Sue Ryder provided NHS-funded community health 30 patients took part in external studies (27 were recruited services through its 6 Adult Hospices, 5 Day Hospices, from two sites for one study and 3 were recruited from one 1 Hospice at Home service, 2 Community Nursing Services site for one study). and 6 Care Homes with Nursing. • During this reporting period, Sue Ryder undertook an • The percentage of NHS funding is variable depending on organisational approach to the Commissioning for Quality the nature of the service and ranges from 35 per cent to and Innovation (CQUIN) scheme. The CQUIN payment 90 per cent of the total cost of providing the service. framework enables commissioners to reward excellence The shortfall is met from Sue Ryder charitable income. and is linked into local quality improvement goals. Sue Ryder • Sue Ryder has reviewed all the data available to it on was successful in negotiating/agreeing 7 local schemes the quality of care in all of the services detailed in the whilst working in partnership with those commissioners preceding section. who wished to transfer Sue Ryder Services to the NHS • The income generated by the NHS services reviewed in the Bi lateral Community Contract. The quality improvement period 1 April 2010 to 31 March 2011 represents 100 per and innovation goals were agreed as over and above the cent of the total income generated from the provision of main contractual requirements therefore attracting NHS services by Sue Ryder for the period 1 April 2010 additional income through the CQUINs payment to 31 March 2011. framework on evidence of achieved goals. In quarter 4 of • During the period from 1 April 2010 to 31 March 2011 this period, 4 schemes have had confirmed payments, with there were no national clinical audits covering the NHS 2 commissioners now advising that due to financial services that Sue Ryder provides. pressures no CQUINs payments will be available. Further – Sue Ryder sets an annual core audit programme that details of the agreed quality improvement and innovation runs from April – March each year. The core audit goals can be found below: programme is risk driven, and for Hospices and Goal Description of goal Neurological Care Centres includes record keeping, 1 To promote a positive experience for all service users medicines management, falls prevention, pressure ulcer 2 To reduce avoidable harm assessment and management, care at end of life, 3 To achieve patient preferred priorities at end of life environmental and a hand hygiene audit. 4 Equity of access to services and innovation – Homecare services have more recently been given in partnership working in palliative care for training on the audit process and have a service specific non-cancer diagnosis audit programme that began in December 2010. The audit programme includes hand hygiene, infection • Sue Ryder services in England were re-registered with the protection control policy compliance, uniform policy Care Quality Commission by 30 September 2010. compliance and record keeping. Conditions of registration apply to the numbers of service – The monitoring, reporting and actions following these users who can be accommodated in each location. In audits ensure care delivery is safe and effective. Each addition, four services where interim management service reports audit findings into their local Quality arrangements were in place were required to have a Improvement Group. The Healthcare Governance registered manager in place by 1st June 2011. Committee for Sue Ryder receives a twice yearly • The Care Quality Commission has not taken enforcement overview of audit results and actions taken in response. action against Sue Ryder during the period 1 April 10 to – Key learning from the audit programme for this year 31 March 2011. has been that more would be achieved in terms of • Sue Ryder has not participated in any special reviews or improvement if the core audit programme were to investigations by the CQC during the reporting period. be extended over a period of two years. This has been • Sue Ryder did not submit records during the period from agreed and will ensure more time to implement 1 April 2010 to 31 March 2011 to the Secondary Uses recommendations locally and more time to re-audit service for inclusion in the Hospital Episode Statistics which where necessary. are included in the latest published data. • From 1 April 2010 to 31 March 2011 Sue Ryder was not • Sue Ryder was not eligible to be scored for the period eligible to participate in national clinical audits. 1 April 2010 to 31 March 2011 for Information Quality and • The number of patients receiving NHS services provided Records Management, assessed using the Information or sub-contracted by Sue Ryder from 1 April 2010-March Governance Toolkit. 2011 that were recruited during that period to participate • Sue Ryder was not subject to the Payment by Results in research approved by a research ethics committee was clinical coding audit during the period 1 April 2010 to 47 in total. Of these, 17 patients took part in four studies 31 March 2011 by the Audit Commission.

Sue Ryder – Quality Account 20 10/11 23 Annexes Annex 2

Feedback from commissioning Primary Care Trusts Feedback from NHS Leeds (PCTs), the Overview and Scrutiny Committee (OSC), NHS Leeds welcomes the opportunity to comment on the Sue Ryder National Service User Advisory Group this Quality Account from Sue Ryder. We currently ‘Acorns’ and Local Involvement Networks (LINks) commission palliative care services from Wheatfields, an 18 bedded unit which provides inpatient, outpatient and Commissioning NHS Gloucestershire Primary Care community-based care. Trust (lead commissioners for Leckhampton Hospice) We can confirm that the published data relating to NHS Gloucestershire (NHSG) has taken the opportunity to Wheatfields is accurate, but are unable to verify the review the Quality Account prepared by Sue Ryder 2010/11. accuracy of data provided by other services outside of the Leeds area, for obvious reasons. We believe that this account In a shared vision to maintain and continually improve the is a fair reflection of the quality of services provided and the quality of specialist palliative care services in Gloucestershire, chosen indicators for the forthcoming year are both suitable NHSG and Sue Ryder have worked in collaboration to and relevant. establish locally agreed quality improvement targets that include nationally mandated quality indicators We are pleased note the achievements against the The introduction of the Commissioning for Quality and priorities outlined last year and note that standards have Innovation (CQUIN) scheme has provided further been maintained or improved for those units inspected opportunities for ensuring robust quality measures are by the Care Quality Commission (England) or Care in place in future and locally we have been in discussion Commission (Scotland). about their introduction to the existing contract. We are particularly pleased to note the introduction of There are regular meetings with the lead commissioner the Datix risk management and recording tool, which will to agree, monitor and review the quality of services improve patient safety through better categorisation of covering the key quality domains of safety, effectiveness incidents and the identification of trends. We are pleased to and patient experience. Learning from this has influenced see how this has also informed the falls management work strategic development and quality assurance measures in and it would be helpful to see if a reduction in falls occurs Gloucestershire across all specialist palliative care services over the forthcoming year as this work is continued. We under a provider partnership model. would recommend that this information is included in next year’s quality account. The Quality Framework for 2010/11 demonstrates a number of key improvements across services since With regard to priorities for the forthcoming year, we 2009/10. In Gloucestershire NHSG has received assurance welcome the continued focus on service user engagement throughout the year from Sue Ryder in relation to key quality through collaboration with the ‘Acorns’ user group. We issues, both where quality and safety has improved and trust that this includes engagement with carers and family where there have been challenges with remedial plans put members also. in place and learning shared wherever possible. We are also pleased to note the proposals on prevention of NHSG endorse the proposals set out in the Quality avoidable harm from pressure ulcers. This reflects priorities Account and can confirm that we consider the Quality agreed with other local providers in their Commissioning Account contains accurate information in relation to for Quality and Innovation (CQIN) schemes. This is also the quality of services that Sue Ryder provides to the true for the proposals on improving the eating experience residents of Gloucestershire. and nutrition, and is key to delivering high quality fundamental care. Mary Morgan, Associate Director, NHS Gloucestershire We commend Sue Ryder care for their commitment to develop leading clinical staff through the leadership programme, as well-trained and developed leaders help maintain high standards of care and drive through service improvements.

24 Sue Ryder – Quality Account 20 10/11 The proposals for learning from incidents and complaints Camden LINk are also commended; we would also suggest incorporating Camden LINk received Sue Ryder’s Quality Account but were work to address some of the themes already identified such unable to provide comments or feedback this year. as communication. Leeds LINk We look forward to seeing the improvements to the quality of They received the Sue Ryder Quality Account but were services provided as outlined in this Quality Account, and we unable to provide any comments this year. They confirmed feel confident that Sue Ryder will continue to build on their they would like to see the Quality Account again next year. achievements and deliver successfully against the priorities they have identified. We look forward to continuing to work Overview and Scrutiny Committee (OSC) with Sue Ryder care and commend this quality account. They were grateful for the opportunity to comment on the Quality Account but they didn’t feel sufficiently informed of The Gloucestershire Health, Community and Care the quality of Sue Ryder services to be able to offer a detailed Overview and Scrutiny opinion. The Gloucestershire Health, Community and Care Overview and Scrutiny Committee was grateful to Sue Ryder for sharing a draft of the Quality Account for 2010/11 but did not feel able to comment.

Sue Ryder Acorns Group (National Service User Advisory Group)

‘Acorns’ is the National Service User Advisory Group for Sue Ryder and has representation from both service users and their family members. The quality account priorities for 2011-2012 were agreed by Acorns at their meeting in March 2011. The draft Quality Account was then circulated to members for comment and a summary of feedback (incorporating the Sue Ryder response to that feedback) is given below.

There was particular agreement with the focus on being treated as an individual and the promotion of independence and choice.

Acorns told us that the document was a little long but that the priorities within it were the right ones. In response Sue Ryder is to produce a 2-page summary version of the Quality Account. This will flag up that a more detailed document is available if required.

A suggestion was made that all staff should be kept updated on the changing dietary needs of service users. This will support the outcome aims for priority 5 (service user eating experience and nutrition). This suggestion will be incorporated into the work that will be completed this year on the Nutrition and Hydration Policy and accompanying standard. The draft standard will be taken to Acorns for their comments and suggestions.

Sue Ryder – Quality Account 20 10/11 25 This document is available in alternative formats on request.

Sue Ryder 1st Floor 16 Upper Woburn Place London WC1H 0AF

Sue Ryder is a charity registered in England and Wales (1052076) and in Scotland (SC039578). Ref. No. 000608.1.p/0611/B/P/H © Sue Ryder, June 2011. This document will be reviewed in June 2012.