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Our care quality account for 2018/19

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Published by St Giles Hospice, 2019-11-19 10:13:23

Quality Account 2018 - 2019

Our care quality account for 2018/19

St Giles Hospice
Care Quality Account

April 2018 to March 2019


Section Title Page Section Title Page

1 CEO Statement 3 9 What patients say about our organisation 16

2 Statement of responsibilities 5 10 What others say about us 18

3 Looking back: Priorities for Improvement 6 11 CQUIN 18
3.1 C HC Beds
3.2 Hospice at Home Walsall 12 Data Quality 19
3.3 Datix Overview
13 Our participation in clinical audits 20

4 Strategic priorities 8 14 Supporting staff and community to 21
4.1 P atients of the Future have a voice
4.2 C arers Project
4.3 P atient Records Systems 15 Supporting staff with personal development 22
15.1 Workshops and Study Sessions for
5 A review of services 10
5.1 Core service our staff and Volunteers
5.2 Research 15.2 Workshops and Study Sessions
5.3 Assurance for commissioners
5.4 Clinical Effectiveness for Everyone
5.5 Family Support and Bereavement 15.3 St Giles Conference
15.4 QCF Qualifications
15.5 Summer School
15.6 Student Nurses

6 Patient Safety 12 16 Board commitment to quality 24

6.1 Safeguarding 17 Statement from CCG 24

6.2 Duty of Candour 18 Abbreviations and glossary 25

6.3 Prevention and Management of Infection

6.4 Medicines Management 19 Get in touch 26

6.5 Patient Safety Benchmarking

6.6 Tissue Viability

7 Complaints 14

8 Other organisational developments 15
8.1 Supportive Care
8.2 Community and Day Hospice
8.3 Inpatient Services

1. CEO Statement

Emma Hodges This year St Giles has had a Care and the amazing job families
Group Chief Executive Quality Commission inspection and friends already do. Our
and I would like to thank all of consultation work highlights
This is year two of our five year our staff and volunteers for the that many people who are
strategy and we continue to focus welcome they gave inspectors. looking after or providing
on delivering what we planned to The results of this inspection support to a family member
during this period. Our key aims reflect the hard work that goes or friend do not recognise
for this year were to: into ensuring the best possible themselves as ‘carers’. Going
patient care on a daily basis. forward our plans will reflect
• d evelop a more comprehensive this and provide appropriate
approach to our support for Our focus remains on providing and accessible support. Next
family members and carers. high quality care for patients year will see the implementation
with specialist palliative care of some of the plans our ‘carer
• c onsider the patients we will needs and the majority of our and family support’ consultation
be caring for in future years funding supports this. Eighty has prompted.
as a response to the changing percent of our care is provided
demographics. in the community, in particular We have spent time with our
in people’s homes. For our Trustees and senior clinical
• continue to manage our inpatient care, the utilisation teams discussing the changing
resources robustly against of our beds remains higher demographics in our society and
a landscape of rising costs, than average. considered the impact this might
increasing demand and flat have on future provision of care.
income. In our five year This work is ongoing and will
strategy, we outlined ultimately drive a future clinical,
the need not only to workforce and financial strategy.
support patients, but In particular, we are considering
the people who care the growing demand for services,
for them. how we can share our expertise
and the impact of ageing, multi-
We have supported the family diseases and dementia on
members and carers of our hospice care.
patients for many years,
however we wanted to review Phoenix, our service to help
both this work and the support any young person who is facing
that our wider community loss or grieving, celebrated
might find beneficial, over and its fourth birthday this year
above what is already in place and I am delighted to say has
helped more than 500 families
in that time. The Phoenix team,

“O ur focus remains on providing high
quality care for patients with specialist
palliative care needs”


alongside our community of the South Staffordshire St Giles Hospice’s Quality
engagement team, are growing End of Life Care Alliance, Account aims to provide patients,
their work with schools, working collectively to open up families, supporters, the general
colleges, organisations, groups conversations around death public, healthcare organisations
and communities to open up and dying. This work, which and commissioners, information
conversations around end of we hope to roll out further, relating to the quality of services
life support and the impact of underlines our commitment that we provide.
bereavement. to working in partnership
with other organisations This Quality Account describes
We continue to develop to encourage open, honest our future goals as well as
partnerships and relationships conversations about planning reviewing 2018/19. I am very
with other organisations for the future and developing proud of the team at St Giles
and have been part of a new compassionate, resilient and all that our staff, volunteers
network with other voluntary communities. and supporters achieve for
sector organisations as part our patients.


2. Statement of directors’ responsibilities in
respect of the Quality Account 2018/2019

The directors are required under the Health Act 2009 to prepare a Quality Account for each
financial year. The Department of Health has issued guidance on the form and content of annual
Quality Accounts (which incorporates the legal requirements in the Health Act 2009 and the
National Health Service (Quality Accounts) Regulations 2010 (as amended by the National Health
Service (Quality Accounts) Amendment Regulations 2011).
In preparing the Quality Account, directors are required to take steps to satisfy themselves that:
• The Quality Account presents a balanced picture of the hospice’s performance over the period covered;
• The performance information reported in the Quality Account is reliable and accurate;
• T here are proper internal controls over the collection and reporting of the measures of performance

included in the Quality Account, and these controls are subject to review to confirm that they are working
effectively in practice;
• T he data underpinning the measures of performance reported in the Quality Account is robust and
reliable, conforms to specified data quality standards and prescribed definitions, and is subject to
appropriate scrutiny and review; and
• The Quality Account has been prepared in accordance with Department of Health guidance.
The directors confirm to the best of their knowledge and belief they have complied with the above
requirements in preparing the Quality Account.
By order of the Board

..............3..1....0..5.....2..0...1..9.............. Date ........................................................... Chair

..............3..1....0..5.....2..0...1..9.............. Date ........................................................... Chief Executive


3. Looking Back: Priorities for
improvement from 2018 – 2019

3.1 During 2018/19 we What was the outcome? “Amy, Trudi and the
widened access to inpatient rest of the team were so
care for our local community Following the reconfiguration in helpful and professional.”
January 2018 all six beds were
What we did? opened and were operational “St Giles is a wonderful
by April 2018. Since that time, organisation.”
We invested in a reconfiguration up until end of March 2019, we
of part of our inpatient unit in have cared for 27 people. Three “Thank you for your
order that we could offer six of these people remain resident dedication, kindness and
new single en-suite rooms for at the time of reporting. The empathy to our loved one
people who are at end of life and majority of people remained while he was in your care.
eligible for fast-track Continuing with us for less than a month He could not have spent
Healthcare Funding (CHC). This with three staying with us for his last months in a better
included social spaces for both over three months. In some environment. He became
residents and families as well as cases, people have been able to settled and confident
access to daily activities. These transfer to our CHC beds after with you and recognised
beds enabled us to increase our having their care stabilised by the all the exceptional care
overall provision of inpatient care specialist team, rather than face you gave him. We would
and widen access to people who a further move to a care home also like to thank you
needed a different type of care. which supports their continuity of for your kindness and
Previously this type of care would care in familiar surroundings. professionalism towards
have been provided in a care all his family and visitors.”
home as the person’s care needs “Tony experienced the
would not require the input of our ‘end of life’ care that he
full specialist inpatient team. wished for.”


3.2 In 2018/19 we piloted accessed it with all stating they support our staff and volunteers.
a new Hospice at Home would recommend it to friends
service in Walsall and family who needed similar What was the outcome?
care. This small service provided
What we did? 437 visits, 208 during the day and We have now successfully
229 at night in the nine months introduced and embedded Datix
St Giles Hospice has operated the service was operated. In for all areas of the hospice.
a commissioned Hospice at virtually all cases people who This has enabled us to better
Home service in Staffordshire wished to remain at home to die capture, review and learn from
and Birmingham for many years. were able to do so. The detailed incidents, accidents and events.
We have been mindful that the outcomes, costings, learning The system has ensured that
community in Walsall has not and recommendations have the right people are involved
had access to this kind of service. been shared with commissioners as promptly as possible and
In 2018 St Giles Hospice, after to assist them consider future reviews are undertaken in a
financial support from Trustees, potential options for such a timely and transparent way.
embarked on a 12 month ‘proof service in Walsall. The system has supported a
of concept’ project to provide learning culture by sharing the
a Hospice at Home service in 3.3 In 2018/19 we completed process, learning and outcomes
Walsall. 12 months funding was the implementation of Datix: with all involved. We have in
allocated for this service and, an electronic reporting year reviewed the quality of
in collaboration with Walsall system for incidents, reporting and management
Healthcare, Commissioners and accidents and events and supported individual teams
GPs and primary care teams, to best use and benefit from
the parameters for the service What we did? the system in practice. In turn
were developed. this has enabled us to revise
The Datix system was introduced and develop support, policies
What was the outcome? right across our organisation in and educational initiatives to
April 2018 supported by a full enhance our care and other
The service was extremely well implementation programme to hospice activities.
received by the families who


4. Priorities for improvement 2019/20

4.1 Patients of the Future • T he cost of delivering our care and monitored directly by our
will increase. Board to whom we will report 3
How was this identified as monthly as to our progress.
a priority? • O ver 50% of people in South
Staffordshire are dying in 4.2 Developing a new strategy
Our preparedness for the hospital which is higher than for carers and family support
changing national demographics the national average, whilst
in our population will be critical proportionately fewer people How was this identified as
to ensuring we are in a position are dying at home. a priority?
to provide the right care to our
community in the future. What are we aiming to achieve? Support for families and carers
has always been part of the
As our demographics change, We want to consider who the hospice’s care and support
in particular people with patients of the future will be and and has traditionally been
multiple illnesses, people with in what ways we could meet included as an integral aspect
complex symptoms at end of their needs in an affordable and of clinical strategy. Given the
life or conditions other than sustainable way. This will mean changing population there is
cancer, we need to consider our we must carefully consider the an ever-increasing pressure on
future service and workforce expected and likely types of services with more people with
development needs. people and their needs that we complex needs being cared for
will be caring for in the future. at home. As such, carers require
• The number of people dying in Then we need to ensure that our support that enables them to
Staffordshire will increase from care services are designed in fulfil their caring role effectively
11,126 in 2016 to 14,238 by 2039. such a way and that our workforce and maintain their own physical
has the right structure and skills and mental well-being. The
• A lthough more people are to deliver the care needed. This offer of support for carers is
dying it is expected that those includes both paid staff and entwined with the care of the
who die below the age of 75 will volunteers. In addition, we must patient, we will look to build on
decrease whilst the number make sure that we can afford to this in developing carers support
of people dying aged between fund these changes as we make services which address the
75 and 84 will increase by 7% them and in the longer term. unique needs of the carer.
and the number of people
dying aged 85 and above will How will progress be A recent report from Hospice
increase by 84%. monitored and reported? UK (2018) has argued that there
is a need for a step change and
• T here will be a 61% increase Over the coming year we will cultural shift among staff in
in the number of people dying produce three plans to ensure the support that is available for
of ‘frailty’, with co-morbidities we can achieve our overall aim; a carers of terminally ill people.
including dementia, cancer and plan for the design of our clinical Feedback from families who
other palliative conditions. services, one for our workforce are engaged with the hospice
and one that sets out our highlights that many family
• H ospice UK predicts that 1 in 4 financial planning to support this. members who are caring
people who could benefit from for people at end of life do
hospice care do not currently How will we know what we not recognise and identify
access it (this is based on have achieved? themselves with the label of carer
palliative conditions and does – we are therefore extending our
not include frailty). These plans and their strategy to encompass family
implementation are fundamental support and carers.
• T he proportion of people with to the strategy for our
complex co-morbidities will organisation and will be overseen
also increase.


What are we aiming to achieve? expect to experience in terms of What are we aiming to achieve?
access to support. Each element We are working with
We recognise that carers and of the strategy will be assessed commissioners, neighbouring
family members may need against clear outcomes as well as hospices and our local health
different things at different times, carefully considered evaluations. economy partners in care to
and that ensuring their needs are explore this together. There is
met is a collective responsibility. 4.3 Ensuring interoperability work happening across our local
of electronic patient record NHS concerning how healthcare
By working collaboratively with systems information can best be shared
our local community and other to support improved patient care.
services we will develop our How was this identified as This will help us decide which
current approach to supporting a priority? healthcare record system we
carers and family members should switch to. Our Trustees
to ensure that locally anyone Our current electronic system will support investment to make
caring for, or supporting has been in place for over 10 this happen once the right
someone living with an incurable years and has some limitations, system has been identified.
illness, can be supported and the most important of which How will progress be
enabled to fulfil their vital role in is that it cannot ‘talk’ or share monitored and reported?
caring, for as long as they wish, information with other systems This is a strategic priority for our
whilst maintaining their own in use by our local NHS partners, Board so our progress will be
health and wellbeing. such as GPs. reported on and discussed at
every Board meeting.
How will progress be The ability to view or share How will we know what we
monitored and reported? records between other health have achieved?
care teams and ourselves in real Ultimately we will have identified
Through consultation and time would improve patient care the right system to support
engagement, both internally by ensuring clinical information is interoperability with other
and externally we will develop up to date, readily available and healthcare record systems and
and launch a strategy for Family that care and management plans have a plan for implementation.
Support and Carers. This will be a are shared and understood by all
three year strategy and a detailed healthcare professionals involved. 9
operational and implementation This in turn ensure decisions are
plan will be developed alongside made in a timely way and in the
the business plan. This will best interest of patients.
necessarily include financial
modelling and plans for
identifying potential funding.

These plans will include
milestones and outcomes
which will be reported to our
Board quarterly.

How will we know what we
have achieved?

Although the strategy itself will
cover three years, it will provide
a clear vision and plan which will
be shared across our catchment
with public and professionals
and all those involved in its
production. It will clearly set out
what families and carers can

5. Review of services

5.1 Core Services by our local community through 5.2 Research
fundraising and the Hospice’s
During 2018/19 St Giles Hospice own subsidiary companies. In year we have further
was contracted to provide six strengthened our commitment to
core services to the NHS: The Hospice’s Care Services research by appointing Professor
Governance Committee Sue Read of the University of
The services were as follows: receives quarterly reports Keele to our Board.
which enable them to review
• C linical Nurse Specialist the quality of care provided by The hospice has continued to
Community Team all our clinical services. The maintain its research activity
committee reviews: and has participated in or
• H ospice at Home is undertaking a number of
• A ccidents, incidents or research studies to benefit future
• Day Hospice near misses patients including:

• Outpatient care • Drug errors • With University College London
we are a site for a study called
• Lymphoedema Clinics • Patient falls The Prognosis in Palliative
care Study II (PiPS2). This study
• Inpatient care • Complaints or concerns closed in April 2019.

The total value of services • P atient and Family Outcome • With King’s College London
provided by the hospice in Measures we are a site for a cohort study
2018/19 was £10,588,070. The called C-Change Work stream 4:
NHS statutory income, which • Service developments Testing a case-mix classification
contributes to our core charitable in palliative care. This study
palliative care services, has The Care Services Governance closed in September 2018.
remained static despite costs Committee then provides quality
having increased. Over £7 million assurance to the Board.
of our funding was generated


• W ith Manchester University 5.3 Assurance for NHS 5.4 Clinical effectiveness
a study called Implementing Commissioners in year
person-centred assessment • 100% of patients who receive
and support of patients and St Giles Hospice has sent care from our Hospice at
carers in a hospice inpatient the three principle Clinical Home team were enabled to
setting. Commissioning Groups with die at home.
which it contracts a Quarterly
• W ith Surrey University a study Quality Report. We have • O verall, people who receive care
called An Observational Study met regularly with these from the hospice are nearly 25%
of Diagnostic Criteria, Clinical commissioners throughout less likely to die in hospital.
Features and Management of the year, where the contents of
Opioid - Induced Constipation these reports form the basis for • 93% of urgent referrals took
(OIC) in Patients with Cancer discussion and review. one day or less to be received
Pain – The StOIC Project. and initial contact made with
St Giles closed as a study site The reports cover key patient the patient by the Advice and
in July 2018. safety topics including the Referral team. We completed
reporting, monitoring, prevention this triage, when we match
• W ith Keele University Exploring and management of: our service to the person’s
hospice care from the needs, within one day for 82%
perspective of people living • Falls of referrals. We were pleased
with multiple sclerosis: An to be able to maintain our high
exploratory case study. • Pressure ulcers degree of responsiveness to
• W ith Sheffield Teaching • A ccidents, Incidents and
Hospitals NHS Foundation Near Misses Overall, during 2018/19 94%
Trust A multi-centre of patients and their families
evaluation of excessive saliva • S afeguarding (including where reported a positive outcome
management in patients with associated with Deprivation of
motor neurone disease Liberty and Mental Capacity) 5.5 Family Support and
The hospice has also been • Infection Control
expanding its knowledge and • 96% reported that the
experience in conducting • Medicines Management intervention they received had
research through supporting helped to support them with
staff to complete masters and • Complaints their distress or grief
doctoral level programmes.
• P atient and Family Reported • 100% were satisfied with the
We have expressed interest in Outcome Measures. service provided and 99%
other research studies that are indicated that they would
planned for 2019/20 and we In year we shared the root cause recommend our service to others
will be reviewing our Research analysis following an outbreak of
Strategy. Norovirus. There were no areas • 93% reported that the service
of concern raised which required was offered at the right time
action although we did revise
our Norovirus Toolkit and made
our information for patients and
families more robust.


6. Patient Safety

6.1 Safeguarding Antimicrobial audits. We contractors concerning infection
undertake Hospice UK’s Health prevention were also produced.
There were four referrals and Social Care audit annually.
regarding potential safeguarding St Giles Hospice has a Service
concerns. We continue to provide Infection prevention and control Level Agreement with University
staff with booster training in year champions, made up of qualified Hospitals of Derby and Burton
concerning the Mental Capacity and unqualified ward staff who for Pathology specimens
Act, Deprivation of Liberty and undertake monthly audits on and Infection Prevention and
Safeguarding. handwashing, sharps boxes and Control advice. The Infection
cleaning equipment. Prevention and Control Nurse
6.2 Duty of Candour is a member of the Infection
Annual, mandatory infection Prevention Society and Hospice
In 2018/2019 there was one prevention and control training UK’s Infection Prevention and
matter where the legal Duty of is given to all our clinical staff. Control Forum and also networks
Candour applied, this was in Tailored training for ward regionally with other hospices
relation to a fall and was handled volunteers and housekeepers to ensure we are up to date with
in line with our policy and our was introduced in 2018. best practice.
regulators were informed.
Patient information and several 6.4 Medicines Management
6.3 Prevention and policies were updated over the
Management of Infections year, including our Norovirus In year we analysed our rate of
toolkit which helps us prevent and errors concerning medicines
Preventing, reducing and manage this common infection. administration. The error
managing infections is a priority rate was 0.06%, meaning
for St Giles Hospice. To assist An algorithm to assess and less than 1.2 errors per 2,000
with this we undertake the respond appropriately to loose administrations, showing our
Infection Prevention Society’s stools was reviewed; a risk medicines administration
(IPS) audits throughout the assessment to support the safer processes and delivery are
year covering both Whittington visiting of pets to our hospice safe. To ensure that the hospice
and Walsall sites along with and information for external can evidence safe working we


undertake four national audits use, benefits, potential harm and medication errors with other
during the year - Self-Assessment and any off-license use hospices both regionally and
Audit for the Controlled Drug supported by improvements in nationally. No variations that
Accountable Officer (CDAO), documenting these discussions might give cause for concern
Controlled Drugs, General were identified in year.
Medicines and Medical Gases. • E nsuring different strengths
The audit tools have been of the same drug are stored in In total during 2018/2019, 453
developed by Hospice UK. a manner which minimise risk patient safety incidents were
The outcome of the audits are and ensuring this is monitored reported all but one resulted in
reported back to the Medicines regularly. no or minor harm to patients.
Management Committee with This shows that our staff are
recommendations and action In 2019 we launched our Hospice confident and willing to report
plans to resolve areas of any Medicines Formulary which events related to patient safety.
non-compliance or inconsistency. supports consistent practice
Actions from this year included: based on best available evidence. 6.6 Tissue Viability
The hospice employs a Specialist
• I mproved signage to remind Palliative Care Pharmacist to The hospice introduced a Tissue
nurses when amending any support best practice and ensure Viability Nurse in 2018/19. In year
corrections to the CD register robust patient safety. she has reviewed and revised our
policies and processes to bring
• A greeing review and 6.5 Patient Safety them in line with new national
documentation of our stock Benchmarking guidance and to support both our
levels with pharmacy staff and care in practice.
The hospice compares its data
• I mproved information for concerning occupancy, falls, 13
patients regarding medication pressure ulcers, infection rates

7. Complaints

We work hard to provide the highest standards Emerging themes concerned communications
of care to patients and families. We believe any particularly focused on exploring and managing
concerns or complaints are an opportunity for us the expectations of patients and families. Work
to learn and improve and are addressed positively is being continued to address this and ensure a
and proactively. consistent approach.

There were eleven complaints during 2018/19
concerning care. None were upheld in full, seven
were partially upheld and four were not upheld.


8. Other organisational developments

8.1 Supportive Care partnership with other local the hospice to patients and
agencies and groups for people families who would not have
• I n May we held a very within their local community – It been to the hospice before.
successful study day exploring involves bringing local people We have recently finished a
new ways of thinking about together for a short exercise six week programme working
grief: ‘The range of responses and information session alongside the therapy team
to loss’. This model can apply focusing on how they can which covered topics such as
to individuals and families maintain their wellbeing and Active Aging, Gadgets and
both facing and following safety at home. Gizmos, Falls Prevention and
bereavement. It received How to Prevent Infection.
positive feedback and 8.2 Community and 8.3 Inpatient Services
subsequently a number of those Day Hospice In July we appointed an Associate
who attended have shared their Practitioner. This was a first for
experiences of integrating their • I n year we commenced a the hospice and is a new and
learning into practice project working alongside innovative way of supporting our
GP’s to integrate primary nurses and creating new roles
• T he Supportive Care Team care services at ‘end of life’, and career paths for nursing
were involved in piloting the using resources appropriately, staff. We have also been creating
use of the ‘Social Impact App’. reducing duplication, improving a development programme to
The App enables the collection communication and most enable our Healthcare Assistants
of evidence in real time of the importantly ensuring that the to work towards becoming
difference interventions are patient sees the right person Associate Practitioners This will
making, such as the well-being and at the right time. be done in conjunction with one
groups, and also to begin to of our University partners.
capture and collate feedback • W e were commissioned by
on the evidence of the impact Staffordshire CCGs to support 15
early interventions have on nursing home staff caring for
building resilience. their patients at the end of life
and reducing unnecessary
• W e have further increased admissions to acute hospitals,
the number of Bereavement enabling residents to die in the
Help Points, widening access nursing home if they wish. In
by launching services in new year we supported nine care
towns and during the evenings. homes with their planning
We now support over 400 ahead register and care
bereaved people each week, planning. 88% of the residents
with an average of 40 new on the register who died, did
people being seen. Our model so in their preferred place of
has been replicated by other care. Of the 11 residents who
hospices and we have been died in hospital, clinical review
asked to make presentations identified that all admissions
about it at national and were appropriate. The project
international conferences. is being extended to 25 homes
during 2019/20.
• W orking with a number of GP
surgeries we have developed • W ellbeing Day is an
and evaluated the impact of opportunity to open our doors
Supportive Care wellbeing to patients earlier in their
programmes, delivered in illness. It’s an introduction into

9. What patients say about our organisation

We ask patients and their families about their experience and the difference we have made for them.
We had feedback from 592 patients and carers.
94% of patients and their families said that they would be extremely likely or likely to recommend
St Giles to friends and family if they needed similar care.

Experience score comparison


Day Hospice

IPS Whittington
IPS Walsall


2017/18 2018/19

Here are a selection of thank yous and comments “I cannot thank the St Giles
team enough for all the
“Everything that was done was care given to Mom in such
carried out sensitively and most a professional way but also
compassionately throughout and showing empathy, kindness
ensured that my late wife was and promoting dignity and
not anxious or in pain for which I privacy at all times. They also
am eternally grateful.” gave me so much support and
kindness at a very difficult
time. Thank you very much
you are wonderful.”

“I just wish to say thank “I knew my Dad was dying but as
you from the bottom of he wanted to die at home. The
my heart. With our CNS CNS made that possible with pain
support in conjunction with relief and the help of the district
that of the district nurses nurses. My mother died in St Giles
and family we were able – it is a wonderful facility.”
to fulfil my husband’s end
of life wishes. His death
at home was peaceful,
pain free and he was
surrounded by family.”


“I thoroughly enjoy myself “The Day Hospice and the
at St Giles. I miss it when care and advice I have
I’m not there.” been given has helped me
tremendously to control
my anxiety and to enjoy
each day as it comes.”

“St Giles gave my “Although mum was only there for
family a sanctuary about 24 hours we were made to
caring for my husband feel very welcome and were kept
with utmost care and informed at all stages. It made a very
respect allowing us difficult time somewhat easier –
time to be together thank you all.”
with total confidence
until the end.”

“Seven days care – on my ”I didn’t realise how
feet again and off home. life saving St Giles was
What a wonderful place.” for dad and myself.
Staff, facilities and
“The fact that the hospice support have been
enabled him to remain at amazing and I would
home was paramount.” love to help in terms of
in future. Thanks so
much for allowing a
peaceful ending.”

“My Dad was lovingly cared for by your truly dedicated
staff – always on call. You were gentle and loving, with a
smile and a sense of humour (which he loved), no matter
how many times the bell was rung. The support you
gave me every day will never be forgotten.”


10. What others say about us

On 6th March 2019, we underwent a 3-day unannounced inspection by the Care Quality
Commission. Although we have not yet received the report or our quality rating, no matters of
concern requiring immediate action were notified to us.
On 5th November 2018, Staffordshire CCGs undertook an announced visit. They said

“Overall impressions are of an innovative and forward
thinking organisation which is dedicated to offering the
best possible care to patients at the end of life.”

There were no issues or concerns raised that required action.

11. CQUIN goals agreed with our

Birmingham and Solihull CCG gave us a CQUIN for 2018/19 based on the Outcomes Assessment and
Complexity Collaborative. This is validated and evidence based set of measures which support excellence
in the clinical practice of specialist palliative care. The hospice successfully met its CQUIN which included
collaborating and working with other hospices to enable us to best learn from each other.

12. Data Quality

We currently hold 64,593 • 2 11 appointments were made • 77% wanted information.
electronic records. for a member of our Medical
Team to see patients in their • 1% were seeking emotional
We submitted our Information own home or at a Consultant support.
Governance Toolkit assessment outpatient appointment.
in March 2018. The outcome • 12% were referred onto another
was satisfactory for this year’s Inpatient Unit - Whittington service.
toolkit and we again passed the
required standard. This enables • 3 60 patients were admitted. • 4% required hospice support
us to continue to use NHS mail and were referred on to us.
and access hospital test results • 3 3% were discharged home or
which in turn allows us to make to a care home. • 3% wanted information about
clinical decisions quickly and symptom control.
share information securely. • T he average length of stay was
15 days. Of the calls to ARC from people
In 2018/19 we offered support known to us:
to the following people • T he average occupancy level
was 75%. • 1 4% were with patients.
• 1 ,488 patients were supported
at home – 1,181 of which were Inpatient Unit - Walsall • 2 1% were with carers or family
new patients. members.
• 2 57 patients were admitted.
• 6 11 people stayed in our • 6 5% were from/to healthcare
inpatient units at Whittington • 3 8% were discharged home or professionals supporting the
and Walsall. to a care home. co-ordination of patient care.

• T here were 4,480 attendances • T he average length of stay was • An additional 1,496 calls were
to our Bereavement Help 12 days. made in respect of referral
Points, an increase of 31%. triage assessment where we
• T he average occupancy level speak with patients, families
• T here were 2,762 attendances was 76%. and healthcare professionals to
to our Lymphoedema Clinics. ensure we offer the right care
Advice and Referral Centre to each person.
• A n average of 48 people a
month benefitted by attending Our Advice and Referral Centre Referrals 2018/19
our Day Hospice and an (ARC) handled over 25,000 calls
average of 58 people a month during 2018/19. • Community - 1259.
attended our Wellbeing Day
which is held once a week Of the calls we received where • Hospice at Home - 362.
throughout the year. the caller/patient was not
previously known to us: • Day Hospice – 313.
• 3 ,137 visits were made by our
Hospice at Home Team to • 5 6% of calls were from • Lymphoedema Clinic – 644.
people at home. healthcare professionals.
Of these 87% went on to receive
• 6 ,764 visits were made by our • 4 3% of calls were from care.
Community Nurse Specialists members of the public.
to people in their own home. 580 new referrals were made
• 1 .5% of calls were from social to District Nursing Teams – this
care professionals. meant nearly 39% of patients
being referred to specialist
• 6 8% of calls were on behalf of palliative care were not already
the patient. known to a District Nurse. This
was an increase of 3% compared
• 3 % wanted advice regarding to 2017/18.
practical issues.


13. Our participation in clinical audits

Planned Audits Outcome

Self-Assessment Audit for the Audited against a nationally developed tool from Hospice UK we were
controlled Drug Accountable able to evidence 100% compliance.
Officer (CDAO)

Health Records including Throughout the year we averaged 96% compliance – each quarter the
Moving and Handling results were fed back to the team highlighting both good practice and
areas for improvement. Specific areas of inconsistent practice are
regularly revisited by the senior team to support staff.

Infection Prevention and We audit against the Health and Social Care Act to provide evidence
Control that the management of our service is compliant on the prevention and
control of infections. Using an updated national tool from Hospice UK
we evidenced 98% compliance. The re-audit identified that information
provided to patients and the public needed to include the importance of
appropriate use of antimicrobials.

Diligent auditing and monitoring by Infection Control Lead and support
staff ensure prevention is a priority within the hospice:


• Compliance rate of 100% for hand hygiene practice

• Q uarterly auditing of patient bedrooms, bathrooms and toilets – average
compliance score of 99%

Yearly auditing comprised 24 individual audits of a range of areas
including kitchen, food storage and handling: sluice, clean and dirty
utility, laundry; sharps, protective, respiratory and moving and handling
equipment: public areas: staff health – average compliance score of 93%

Medicines Management Yearly audits are undertaken using national tools developed by Hospice
UK. For Controlled Drugs we averaged 98.5% compliance, for General
Medicines the average compliance was 97.5% and for Medical Gases the
average compliance was 91.5%

To ensure we remain vigilant we audit quarterly using tools developed
by our palliative care pharmacist – overall we averaged 93% compliance
during the year.


14. Supporting staff and our community
to have a voice within our organisation

We celebrated the first sessions have made us realise We also hosted an art exhibition
completed year of our five year there is an appetite for this type entitled ‘Arts for Life’ which
strategy in September 2018 by of work within this community. demonstrated the connection
holding a series of events across The sessions were tweaked between art and hospice life.
our catchment. as learning was gathered and Local schools, art societies, day
further sessions were requested hospice patients, dancers and
In 2018/19 St Giles engaged by the group. poets all engaged to showcase
with a variety of community the relationship between art and
groups which supported mutual We have also engaged with a end of life care.
learning and exploration. local Stroke Association on the
These included a voluntary subject of Care Planning, the Staff and volunteers continued
organisation that supports group found the sessions very to be involved in Listening into
people with learning disabilities useful and in turn they have Action, an NHS organisational
and the South Staffordshire helped us with a project we are development and improvement
Mental Health Network. currently involved in around tool, of which St Giles Hospice
care planning. was the first hospice to be
We have also engaged with a involved. This included a work
group of women from different During the national Dying stream on staff wellbeing.
generations (age range 40 to Matters Week in May 2018,
90s) from mainly South Asian we held several events and Throughout the year the
origin who meet on a weekly workshops across our catchment senior management team hold
basis in Walsall where discussion area. Working in partnership monthly hospice briefings
around death dying and with Tamworth Cooperative which all staff and volunteers
bereavement was facilitated on Funeral Service, we held a pop are free to attend, besides
a monthly basis for two months. up shop in Tamworth, where we providing updates on what is
Conversations around death, invited the public to pop in, have happening across the hospice
dying and bereavement were a tea of coffee and discuss death it is an opportunity for staff and
facilitated and these monthly and dying related matters. volunteers to ask questions.


15. Supporting staff with personal

15.1 Workshops and study Induction Days for Mandatory Study Days for
sessions for our staff and New Staff and Volunteers Clinical Staff
Mentorship Updates provided by Moving and Handling Key
St Giles Education and Training Local University Partners Worker Training
department is committed to
providing a wide variety of Sage and Thyme
learning opportunities for our
own staff, volunteers and external Wound Care/Tissue Viability Fierce Conversations
staff working in all sectors of Study Day
health and social care. Introduction to Palliative Care
Student Enrichment Day for HCAs
The training we continue to
offer to our staff, seeks to give Healthcare Leadership (SLAIP)
patients, carers, professionals
and our local community OSCE (Observed Structured Clinical
confidence in our skills and the Examinations) programmes
opportunity to promote good end
of life care for all.

In addition for 2018/2019 we held the following enabled by
external facilitators:

Defensible Documentation

Healthcare Records on Trial

ROSPA Health and Safety

15.2 Workshops and study • R egistered Managers Meeting in • Dementia Awareness sessions.
sessions For everyone partnership with Skills for Care. • Deputies Network – Community

We have developed and extended • I ntroduction to Palliative Care of Learning.
external clinical and non-clinical for Registered Healthcare • Leading and Managing Services
education programme in Professionals.
response to local and national to Support End of Life Care.
needs for external delegates. • S upporting Children and • Nutrition Study Day.
Young People Facing Loss • The Role of the Coroner.
Our own staff also have the or Bereavement. • Pulmonary Trust Awareness
opportunity to attend these
sessions. • S kin Care in Palliative Care. Session.
• Working with Groups.
• T our and Talk open to everyone, • M ND Awareness Session. • Range of Response to Loss.
adults and young people over • Advanced Care Planning.
the age of 14 who want to know • I ntroduction to Palliative Care. • Sexuality and the Health Care Role.
more about us. The tour is led • Exploring Ethics
by a member of the Clinical or • E ssentials in Palliative Care.
Management Team.
• D ementia – Virtual Tour Workshop.
• M enopause awareness workshops.

15.3 St Giles Hospice Raising awareness re the 15.6 Student Nurses
Conferences importance of Advanced Care
Planning (ACP)/Digital legacies. Both our inpatient units offer
Social Media in Palliative Care placements to nursing students
2018 Conference 15.4 QCF Qualifications from Birmingham City University,
Wolverhampton University and
This conference was aimed at any We have put together a varied Stafford University. This year we
healthcare professional providing programme of QCF courses this ran a pilot scheme with students
end of life care, particularly year, covering topics that haven’t splitting their placement between
palliative care colleagues working been offered previously; Dignity time on the IPU and time with the
across a variety of inpatient and and Safeguarding and Customer Community Nurse Specialists.
community settings, including Service. Alongside these new
consultants, specialist registrars, courses we are also offering Whittington Barracks sent six
nurses and those health care Dementia Care, End of Life Care Military Nursing students this
professionals who may be wanting and Customer Service within year, and our Lymphoedema
to know more about social media Health and Social Care Settings. Clinic provided a placement for
and how it might impact on the seven Podiatry students.
future of palliative care. Our End of Life Care course,
which is currently being offered Feedback from students is
“Fantastic, so many great to the South Staffordshire End always excellent and we have
tales, discussions and a really of Life Care Action Alliance, in received requests for elective
informative event.” an initiative to provide end of life placements as a result of
care training to members of the spending time here on the IPUs.
“Excellent speakers and alliance group. In total between These are placements for third
knowledge from them April 2018 and March 2019 we year students who are able to
was fantastic.” will have enrolled 86 learners on choose an area or specialism.
QCF courses.
“I have learned something “Felt privileged to support
new from every speaker today 15.5 Summer School patients and families at the
– so much information – great end of their lives.”
ideas – my head is buzzing.” Ran successfully once again,
in July 2018. We recruited 15 “We were made to feel
“Information today will students from schools across our part of the team which
enhance my engagement catchment area and a full four was very motivating.”
with patients in the future day programme was provided to
and has given me new support and inspire young people “It has been a lovely
exciting ways to help support interested in a career in care. placement, all staff have been
patients to take more control very friendly and welcoming,
of their life/death.” would recommend to others.”


16. Board commitment to quality

The Clinical and Workforce Governance Committee Each meeting has a set agenda which considers core
comprises of four trustees of the main Board, the quality assurance measures, clinical strategy and
Chief Executive, Deputy Chief Executive, the Medical performance, audit results and regulatory reports.
Director, Nursing Director and Director of Supportive
Care. The committee met quarterly as scheduled The Board of Trustees has demonstrated its
during this period and then reported directly to the commitment to, and responsibility for, quality
main Board. In year we made the decision to split by ensuring a robust governance structure for
this governance committee in to Care Services and all aspects of the organisation, with four other
Workforce, Education and Research. governance committees meeting on a regular pattern.

17. Statement from our CCG

The Staffordshire and Stoke on Trent CCGs welcome the opportunity to review the St Giles Hospice Quality
Account 2018 /2 019 and to provide a statement.

NHS funding forms only a small part of the funding required by the St Giles Hospice to operate and
provide the range of services described. It is recognised by the CCGs that the on-going funding from the
local community and the patient, carer and family feedback demonstrate the contribution that St Giles
makes towards supporting the health and wellbeing of the local community. The importance of hospices is
acknowledged and they form part of the long term strategy for Staffordshire.

The CCGs undertook a visit to the Hospice in November 2018 and spent time with the various services
and the respective leads. This was a new approach to quality monitoring which allowed the service to
demonstrate in more detail the ongoing work, improvement initiatives and actions taken as a response of
any incidents or complaints. This will form part of the normal quality monitoring in a move away from a
Hospice focused Clinical Quality Review Meeting. This allows a more specific focus on the Hospice and
gives opportunity for staff to present in detail the individual services and see these in action where possible.
In addition to this visit, St Giles Hospice continues to provide a regular Quality Report which contains detail
about all elements of quality, themes and trends.

From the assurances that we have received we believe that St Giles Hospice provides high-quality care
for patients.

The Staffordshire and Stoke on Trent CCGs look forward to continuing to work with St Giles Hospice in
2019/20, working with the hospice in developing and monitoring the quality of services it provides for all
patients. The CCG wish to state that to the best of their knowledge, the data and information contained
within the quality account is accurate.

Marcus Warnes Heather Johnstone
Accountable Officer Executive Director of Nursing & Quality


18. Abbreviations and Glossary

ACP Advanced Care Planning
ARC Advice and Referrals Centre
CDAO Controlled Drugs Accountable Officer
CD Controlled Drug
CEO Chief Executive Officer
CQC Care Quality Commission
CCG Clinical Commissioning Group
CNS Clinical Nurse Specialist
CQUIN Commissioning for Quality and Innovation
GP General Practitioner
HCA Health Care Assistant
IPS Inpatient Services
IPU Inpatient Unit
MND Motor Neurone Disease
NHS National Health Service
OSCE Observed Structured Clinical Examinations
QCF Qualifications and Credit Framework
ROSPA Royal Society for the Prevention of Accidents
StOIC Study of Opioid Induced Constipation
SLAiP Standards to Support Learning and Assessment in Practice
PIPs Prognosis in Palliative Care Study


19. Get in touch

For further information or advice or if you wish to comment
please contact us the following ways
Write to:
St Giles Hospice
Fisherwick Road
WS14 9LH
[email protected]
01543 432031 (main switchboard)

Registered charity No. 509014


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