Quality Account 2018-2019 - Our Performance, Our Initiatives, Our Priorities
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Quality Account 2018-2019
Our Performance, Our Initiatives, Our Priorities
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-19
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“Richard House was introduced to us when we
were at peak crisis point…not all heroes wear
capes!”
“The respite care at Richard House has helped
the family get some much needed rest and, to
spend quality time together as a family.”
“He loves coming here, it’s a space he calls his,
where he can just be a child. It’s difficult for us
to engage other places. He loves playing with
his little brother there too.”
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-19
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Table of Contents
I. Key Messages
a. Trustee Chairperson
b. Chief Executive Officer
c. Director of Family and Care Services
II. Hospice Information
a. History, population served, range of services
b. CQC Standing
c. Values and Philosophy of Care
d. Research participation
III. Review of Quality Performance - Patient Safety, Clinical Effectiveness and
Patient Experience
Clinical audit; Service evaluation; Service user and family feedback
Patient safety
Duty of Candour; Safeguarding and Consent
Infection prevention and control
Staff survey; Freedom to speak up guardian
Accident and incident reporting; Complaints handling
Pressure ulcers and Falls
Information governance
IV. Caseload Management
Admission, discharge and transfer
Social, therapeutic and resource (STaR) services
Case studies
V. Quality Improvement Initiatives
Internal clinical governance group; MSIG Committee; MDT group
Clinical Governance and Quality Monitoring Committee (Board level)
VI. Priority Improvements
VII. What service users, families and volunteers say about us
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-19
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I. Key Messages
Statement of Quality: Chris Baker, Chief Executive Officer
As a legal requirement, each year at Richard House, we review our
performance against quality measures from the previous year, and set our
objectives for continuous quality improvement priorities. We are committed in
our approach to deliver exceptional care to service users’ with life limiting, life
threatening conditions and their families. In line with national health and
social care priorities, we aim to deliver the highest quality of patient care
through safety and effectiveness and ensure the highest level of
compassionate care. We strive to ensure that staff who are delivering care to service users are developing
and put quality improvement processes at the heart of their approach to care.
This annual Quality Account for Richard House Children’s Hospice is amassed from data gathered from 1
April 2018 to 31 March 2019. This report has been compiled and produced by the Quality Monitoring and
Informatics Lead, Allan Rowe Candido with the support from the Director of Family and Care Services,
Libby Basson and further reviewed up to the board level for strategic and wider organisational view to
quality improvement. This report also draws information which has been gathered from relevant personnel
from hospice at home, residential care unit, care administration and social, therapeutic and resource
services.
Special Acknowledgements:
Carol Butwell - STaR Services Manager
Elaine Reid – Care Manager
Gita Pratiwi & Liz Steggall – Executive Assistants
Hollie Mann – Head of HR and Volunteering Engagement
Hope Lanek – Marketing Executive
Jean Harrigan – Senior Care Administrator
Jo Inskip – Head of Communications
Julie Gadsdon – Care Administrator
Kessington Ijegbai – Director of Finance and Operations
Sheryl Simon – Specialist Palliative Outreach Nurse
Trish McInerney – HR and Volunteer Engagement Administrator
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-19
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Statement of Improvement: Libby Basson, Director of Family and Care Services
Here at Richard House, we have a culture of continually working to
monitor and improve quality. We actively seek feedback from our
service users and their families and they are encouraged to make
suggestions and feedback to members of the Executive Team.
We work in partnership with our colleagues who support our children
and young people in acute, community and palliative care, to ensure
our services are holistic, needs-led and family centred.
Quality is integral to any growth in, and development of our services. We will continue to review our
palliative care services to provide a safe, caring, effective, responsive and well led service. We will achieve
this by robust clinical governance and quality monitoring process.
Our focus for improvements in 2019/2020 will be (but not limited to):
Utilising electronic patient recording system called ‘The Care Database’ to facilitate smooth referral,
booking, admission, and care planning for service users and family
Work in liaison with our partners in North East London to develop an integrated End of Life Care
Pathway for infants and children (NICE Guidelines, 2017), providing families with a choice in location,
including their home
Using technology as a tool to improve patient safety and clinical effectiveness
Re structuring of senior clinical team to improve care services and case management
Enhancing training and staff development to increase staff retention, improve skill mix and reduce
the use of agency staff
I am exceptionally proud for the commitment, hard work, compassion and dedication portrayed by all care
and support staff who delivers services in our residential, hospice at home and community activities for our
service users and their families.
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-19
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II. Hospice Information
Our Vision, Values and Philosophy of Care
Our Vision is for communities to have a space where they can journey together to create memories
of LIVING and DYING.
We take pride in our Values…
We create a happy and POSITIVE environment for all. We are RESPECTFUL and welcome people
from all our diverse communities and treat them with care and respect. We value openness and
INTEGRITY in all our dealing. Our DEDICATED staff and volunteers put children, young people
and families at the centre of our work. We are passionate about achieving EXCELLENCE in all we
do.
The cornerstone of our philosophy is that
children/young people with life-limiting and life
threatening conditions and complex health needs,
and their families, have access to QUALITY CARE
and support to meet their physical, emotional,
spiritual and everyday practical needs.
Families’ choice, empowerment and well-being remain
at the HEART of all we do. We value our ability to
partner with parents and family members in the care
of their children and this PARTNERSHIP is
paramount in our philosophy of care. We also
recognise that young people, as they become independent, must have a CHOICE and be supported
in determining their own needs and preferences.
We aim to offer HOLISTIC, MEANINGFUL CARE that responds to the need of each individual,
working in partnership with our agencies and services, to prevent duplication and to fill gaps in care
provision.
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-19
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History, Population and Range of Services
Opened in 2000, Richard House is London’s first children’s hospice. It was founded by Anthea Hare, who
was inspired by both her experience as a paediatric nurse at Royal London Hospital in Whitechapel, and
through helping her parents look after her severely autistic brother.
Today, Richard House cares for over 300 children from around London, e.g. in the boroughs of Newham,
Barking, Dagenham, Tower Hamlets, Waltham Forest, Hackney, Redbridge, Haringey, Islington, Ilford,
Camden and beyond.
From the moment a child is diagnosed with a life limiting, life threatening or complex health condition,
everything changes. These changes affect the whole family, which is why we feel it is vital not only to
provide care to the child but to support the whole family.
Richard House provides a family-centred, needs led, and outcome based service to ensure that all
psychological, physical, emotional, social and spiritual needs of our children, young people and families are
met.
Our services include:
Clinical care for children and young people with complex health care needs
Step down care – smoothing the transition from hospital to home
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-19
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Short stays – taking pressure off families and giving children opportunities to enjoy social
interaction
Hospice at home – to provide respite or end of life care to a child at home
Trips and family days – enabling children and their families to enjoy activities they couldn’t do
otherwise
Group sessions – providing a supportive environment to meet with others in similar situations
Music therapy
Psychotherapy – available to children and young people, their parents and siblings
Transition service – providing young people with information, advice and referrals to relevant
specialist services
Oncology services – providing support for children with cancer and their families
Symptom management – ensuring pain and symptoms are minimised
End of life care – providing end of life care at the place of choice by families
Bereavement support – for the family during a child’s illness and following the child’s death
from our qualified practitioners
Richard House Trust acknowledged that service users, carers and the public are essential for the
work of research. Research is important to provide the evidence that something works and will
benefit the overall population in identifying people at risk of getting ill and prevent illness, provide
best advice and treatments to people and find out what people think about services. Currently,
Richard House is not actively participating in any research activity. We have a policy on research and
will be reviewed in the event that Richard House Trust will be approached to participate or undertake
any research activity.
Richard House Children’s Hospice is registered with the Care Quality Commission (CQC).
Elizabeth Anne-Basson – Registered Manager
Chris Baker – Registered Provider
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-19
9 Care Quality Commission (CQC) Standing Last June 2016, the CQC conducted an unannounced inspection under Section 60 of the Health and Social Care Act 2008 as part of CQC’s regulatory functions. Inspections are planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-19
10 Is the service effective? Our findings - Families told us that they were very happy with the care provided and felt that staff were skilled and competent. One relative told us that their child had very complex needs and that this had meant that they had always stayed with their child as although the nurses were very well trained they had not able to carry out all of the necessary tasks. However, nurses had now received specialised training and in future would be able to meet all the child's complex needs. This relative added that they had confidence in the nurses and in future would not stay with their child Is the service caring? Our findings - Families all said that staff at Richard House were very caring. One relative told us, "Very, very good. They're brilliant with people like me and my son. I'm just glad there's something like that for children with complex needs, there's not many places that are as good." When asked if they thought staff were caring another commented, "Definitely. 110%. Very dedicated and passionate about what they do." One young person told us, "Staff are caring" and in a video about the service we saw that another young person had said, "Staff are very nice and do care about you the same way as your parents would." Is the service well-led? When asked about the registered manager one relative told us, "She's lovely. She's dedicated, very open and honest." Can phone up any time; don't need an appointment if you want to speak to her." Another said, "The registered manager is good. She is good at approaching families." Is the service responsive? Our findings Children and young people received an individualised person-centred centred service based on their specific needs, choices and preferences. Support for families was also based on need and preference. The service responded as flexibly as possible to ongoing and changing needs. For example, some people used the service for residential stays, others for day care, music therapy or perhaps just a weekly bath. A nurse told us, "Personalised care is care given to an individual based on individual needs. It's about the person being in the centre of the care and about it being holistic." Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-19
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Is the service safe?
Our findings Families were confident their child was safe using the services provided by Richard House. This
included both the residential unit and sessional activities. One relative told us, "I don't feel worried when [my
child] is there." Another said, "[My child] is happy when there and I feel comfortable leaving them. They know
how to treat them."
Areas for improvement:
“However, records showed that night time fire drills had not been held, there was not a record of which staff
had been present for a fire drill and there were not any personal emergency evacuation plans for individuals.
We discussed this with the provider and they carried out a night time drill and started a record of staff that
had been present. They also spoke to the local fire service and arranged for a fire safety inspection which
took place before our inspection was completed. Action had been taken as a result of the visit based on the
advice given. We also found that hot water temperatures were not checked to ensure they were within a safe
range and that although the registered manager told us that staff checked water temperatures by hand they
did not measure hot water temperatures before bathing or showering children and young people. This placed
children and young people at risk of scalding if a water temperature control valve was faulty.”
Based on the CQC’s report after inspection, Richard House has taken on board special measures to areas
that needs improvement, specifically on the patient safety. We continue to monitor our current practice:
Night time fire drills have been scheduled every quarter across the year and records of staff that
attended is kept.
Personal emergency evacuation plans (PEEPs) have been introduced after the inspection in 2016 and
the risk assessments related to fire are now carried out on an individual, rather than group, basis.
Furthermore, a personal emergency evacuation plan have now been added as a separate section to
each child’s care plan assessment and held as an electronic version on our Care Database.
A scoop thermometer is now used when staff run a bath for a child or young person and they then
makes a record of the temperature. This provides a fail-safe for the electronic thermostat within the
bath that automatically provides water of an appropriate temperature and a record that safe practice
is being followed. The recording of the bath temperature has been added on the daily care notes.
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1912
The above 3 areas will be included in the 2019/2020 service evaluations to monitor our current practice to
ensure our service are kept safe.
III. Review of Quality Performance
Clinical Audit
The English Department of Health1 states that, “clinical audit involves systematically looking at procedures
used for diagnosis, care and treatment, examining how associated resources are used and investigating the
effect care has on the outcome and quality of life for the patient.”
Richard House recognises clinical audit as a vital aspect of clinical governance and continuous service
improvement in care. This lets care providers and service users know where their service is doing well, and
where there could be improvements. We have 3 clinical audit projects, namely: medication optimisation,
hand decontamination and clinical records keeping. This projects are carried out once in every quarter to
allow sufficient time for action plans to take effect in the event when necessary changes in practice has to
take place. There are clinical audit link staff allocated for this task and they have been nominated by senior
clinical members. They are provided the protected time so that sufficient data are collected, hence,
contributing to the overall effectiveness of the audit project.
1
Department of Health (2003) cited in What is clinical audit?. http://www.rcpsych.ac.uk/pdf/clinauditchap1.pdf (accessed 10 May 2019).
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1913
Below is the summary of the 3 clinical audit reports undertaken in the past year
Clinical Audit Report
90
80
70
60
50
40
30
20
10
0
Medication Optimisation Hand Decontamination Clinical Records Keeping
Total Compliance Total Non Compliance
What did we do with the clinical audit results?
Richard House has adopted a new template for clinical audits since the start of the 3rd quarter of
2018. The new programme has replaced the paper based recording into the electronic method.
On completion of the audit, results are shared to the internal clinical governance (ICG committee)
group which is composed of senior care staff. The data are stored in the T-drive so it will accessible
to all staff members and only the clinical audit link staff has access to input and change raw data.
Senior care staff reviews the actual data findings against pre-defined criteria and standards and
report on level of achievement. Any issues of priority and urgent relevance are reflected on the
progress status of the action plan that requires evidence of implementation. For issues that are non-
compliant, e.g. delayed commencement/completion due to time constraints, incomplete records, care
manager and relevant clinical audit link staff are prompted for appropriate actions, e.g. protected
time to carry out task, further review on record completion.
Further, any improvements are reviewed on a regular basis during the Internal Clinical Governance
(ICG) meeting that takes place twice per month at least. Also, staff engagement is encouraged and
issues of difficulty are discussed during staff meetings on team days every 6 weeks.
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1914
Service Evaluation
The National Research Ethics Service (NRES)2 describes service evaluation as a method of assessing how
well the service is achieving its intended aims. It is undertaken to benefit the people using a particular
healthcare service and is designed and conducted with the sole purpose of defining or judging the current
service.
Richard House conducts service evaluations as part of its quality improvement projects and the results are
mostly used to generate information that can be used to inform local decision-making.
Part of this project, includes the following:
Evaluating the completion of PEEP forms
Checking records of admission weight
Completion of the body maps
Daily checklists that includes equipment checks used in the residential unit
Day and night checks
This duty is also conducted by a member of the clinical staff is given protected time to carry out the task.
Richard House acknowledges that caring for our service user can be challenging and demanding at all
times. Whilst patient safety is embedded to the culture of everything we do, the senior management
ensures that this project will not jeopardize their daily clinical routine.
Further, this service evaluation is carried out on a regular basis and is reliant on the quality needs of the
unit. Given that healthcare systems and processes change overtime, this tool is modified accordingly. As
the whole team aims to move forward to a better and safe quality care provision to all service users and
their family, this project will remain dependent on the objective to cover every processes involved in
service delivery.
2
National Research Ethics Service (NRES). Defining research. 2013. http://www.nres.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=355 (accessed 10 May 2019).
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1915
Below are summary graph representation to some of the evaluations we cover.
Care Services Evaluation
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
PEEP Forms Record on Body Maps Day & Night Daily Completion
Admission Checks Checklists
Weight
Total Compliance Total Non Compliance
What did we do with the Care Services Evaluation result?
Actions plans are rolled out in 3 areas:
1. Personal Emergency Evacuation Plans (PEEP) forms was previously completed on a separate
form. We rolled out an updated version of a care database with the option of redesigning our
care plans. PEEP forms are added to the care plans. All children and young people accessing
Richard House now has a PEEP assessment completed as part of the care plan prior to
admission and a current electronic version is available at all times.
2. The recording of admission weight is identified as an area that needs improvement. Although
the service users’ weight should always be recorded in the care plan, it was recognised that
some of the parents were not able to provide the most current weight. The current weight is
important to check that a child is receives the right amount of medicine and to recognise
weight gain or weight loss. We changed our practice and made it mandatory for all children
and young people to be weighed on admission. The use of special scale whilst hoisting a child
is now introduced as part of our induction to ensure every staff is trained in weighing a child
or young person with mobility issues.
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1916
3. It has been recognised that the shift leader are supporting staff in providing personal care
and assist in manual handling whilst completing 2 care plan assessments. Through open
discussion with the staff, we found out that this can lead to insufficient time to complete the
checklist to confirm all tasks are completed. Hence, care plan assessments (completed about
4 weeks prior to admission) is now done primarily by the Clinical Case Manager and the
outreach nurses to allow the shift leader more time to effectively lead the shifts and support
staff. Further evaluations will be conducted to monitor improvement.
Service User and Family Feedback
“If quality is to be at the heart of everything we do, it must be understood from the perspective of
patients”.
Service user feedback consists of the view and opinions of service users and their family on the care
they have experienced. Richard House acknowledged that gathering the views of service users and
family must be carried out systematically to obtain reliable and rigorous evidence. To reflect the main
key line of enquiries (KLOE’s) from CQC, Richard House has formulated a service user-friendly and
easy to understand feedback form for families.
Additionally, Richard House acknowledges that service user experience surveys are the best method
of gathering feedback to know their view, esp. from the families who are witness and oftentimes,
recipient of our support programs.
Below is the feedback results gathered from 1st, 2nd, 3rd and 4th quarter of financial year 2018-19, the
overall summary and the trend. This trend helps us to monitor if there are specific quarters of the
year where one of the key line of inquiries fall short or increase overtime. This way, we are able to
reflect what has happened and set out measures to prevent further occurrence, when necessary.
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1917
SERVICE USER AND FAMILY FEEDBACK
2018/19
100.00
90.00
80.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00
1st Quarter 2nd Quarter 3rd Quarter 4th Quarter
Caring Effective Safe Responsive Well Led
What did we do with the results from service user and family feedback?
Families were given the option to either complete the form anonymously or to leave their contact name
and number to allow a follow up call where concerns were raised. Staff are further advised to comply with
providing feedback to service users and families during discharge especially on the weekends. Care
Manager and Care Administrator will also closely monitor the number of discharges so it will reflect the
evaluations gathered.
“I can really see the difference Richard
House has made. Despite having two major
operations in the past two years, meaning
he needs medical attention every few
hours, Richard House has helped him
develop a greater sense of independence,
and he has the opportunity to live a full
life”.
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1918
She loves coming to Richard House. She gets such a
warm welcome from everyone and gets so much from
her time there. She so enjoys the activities Richard
House puts on, like the ballet workshop. Ballet is her
passion and to dance with a real ballerina was a dream
come true for her.”
Patient Safety
Patient safety3 is the avoidance of unintended or unexpected harm to people during the provision of health
care. Richard House supports all clinical and support staff who are involved in carrying out care and other
activities to all service users to minimise safety related incidents and drive improvements in safety and
quality. Richard House believes that all service users should be cared for in a safe environment and
protected from avoidable harm.
Improving service user safety in care is highly recognised and encouraged. Service users and their families
have a key role in helping to reach and deciding an appropriate care and to ensure that it is administered,
monitored and adhered to, and in identifying adverse events and taking appropriate action.
Inclusive to the scope of patient safety, Richard House recognises the following components outline below
and how they are reflected in our practice and embedded in our organisational culture.
Duty of Candour
A culture of Candour is a pre-requisite to improving the safety of patients, staff and visitors as well as the
quality of healthcare system. In Richard House, we believe that patients should be informed about all
elements of their care and treatment and all staff has a responsibility to be open and honest. We strongly
3
https://improvement.nhs.uk/improvement-hub/patient-safety/accessed 10 May 2019
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1919
emphasized the importance of this through our policy and procedure, and as a requirement in all our
incident and accident reporting esp. when errors happen.
As part of our duty of Candour, we will make sure that if mistakes are made, the affected service user:
a. Will be given an opportunity to discuss what went wrong
b. What can be done to deal with any harm caused
c. What will be done to prevent it to happen again
d. Will receive an official letter of apology from Richard House
We are 100% compliance on our Duty of Candour.
Infection Prevention and Control
In accordance with the requirements of the Code of Practice4 on the prevention and control of infections
and related guidance, under the Health and Social Care Act 2008, Richard House ensures that our clinical
priorities are to protect our service users, visitors and staff from the risk of healthcare-associated infections
cause by microorganisms, e.g. virus, bacteria.
The Director of Family and Care Services, together with the Care Manager is the lead on issues relating to
the prevention and control of infection. All clinical staff underwent mandatory training, e.g. hand hygiene,
and are dedicated to prevent and control cross-infection. Additionally, we carry out clinical audit for hand
hygiene to check that they comply with our strict hand hygiene policy and there are signs at the entrances
and work area in the residential unit to remind service users, visitors and staff – to clean their hands. We
have also subscribed to safety alerts management from NHS Improvement website where we regularly
receive updates related to infection control and prevention.
Below is a snapshot of our latest infection control and prevention inspection from IPC Management Ltd.
conducted on the 24th September 2018.
4
https://www.gov.uk/government/publications/the-health-and-social-care-act-2008-code-of-practice-on-the-prevention-and-control-of-infections-and-related-guidance(accessed 15 May 2019)
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1920
Complaints handling
In addition to providing all patients with an opportunity to complete a service user satisfaction survey,
Richard House actively encourages feedback both formally and informally. Service users and their family
are supported through a robust complaints procedure reflected in our policy guidance through hospice/local
resolution, corporate resolution with the Senior Leadership Team (SLT) and Board of Trustees and if
necessary, service users and their family can refer their complaint to an independent adjudication if they
are not satisfied with the outcome at the other 2 stages.
Complaints are discussed at departmental/directorate level, then to the senior leadership team and to the
Board of Trustees accordingly.
We had 3 complaints, all investigated and closed accordingly. No major complaints that impact Richard
House reputation. Complaints handling is also reviewed by the senior care team and a live action log is
kept to ensure actions to improve service is followed up and where necessary changes to policy and
procedure is brought. Support for staff involved in complaints are provided, and also in clinical supervision.
Complaints handling is a regular action item in the clinical governance meeting both in local and board level
where updates are discussed and different input are recognised. We have an updated policy on complaints
handling and information is provided in the Richard House website.
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1921
Safeguarding
Recognising the signs and indicators of abuse poses challenges for most professionals, especially those
who are not required to respond to safeguarding concerns on a day to day basis. Abuse can be understood
under the categories of: physical, sexual, neglect and emotional.
Richard House believes that all staff has the responsibility to make sure every service user are safeguarded
and protected from abuse and neglect. We strongly acknowledge that all employees and volunteers have a
responsibility to be aware of their safeguarding duties by understanding our safeguarding policies and
procedures. The Director of Family and Care Services is the designated safeguarding lead and is deputised
by the Clinical Case Manager.
All staff providing care to our service users and has a regular contract with children and their families
underwent safeguarding level 3 training underwent safeguarding training as well as safeguarding adults
level 2. All office staff received safeguarding training on the level that is appropriate for their line of work at
the start of employment.
An annual refresher safeguarding training is provided. A DBS is required as part of the pre-employment
requirements and safe recruitment process and all staff delivering care or those who will work directly with
the children and their families have an enhanced DBS no older than 3 years in place.
During the year, we identified 2 cases where we had safeguarding concerns in respect of incidents outside
of the hospice which we reported.
Staff survey and staff safety culture
The delivery of the highest quality care is completely reliant on employees within the health and social care
systems. Their efforts, practices and behaviours both as individuals and teams directly impact on patient
experiences and quality. Richard House, as a healthcare organisation providing services to children and
young adults recognised the importance of understanding staff experiences as a vital component of any
realisable quality strategy. On a yearly basis, we conduct staff satisfaction survey which aims to capture
feedback at the different stages of their journey in our organisation.
Below is a chart that highlights the top and bottom ten variances between the survey done in 2018 and the
previous years.
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1922
Top and bottom 10 variances between the 2018 survey and
previous years
60%
50%
40%
30%
20%
10%
0%
Series 1
-10%
-20%
-30%
It is safe to challenge the way things are done
Working for this charity contributes postiviely to my health and well-being
I am satified with my job
I feel appreciated
This chaity make best use of my abilities
My line manger is a good person to work for
I rarely get stressed at work
I am proud to work for this charity
I get the support I need to enable me to do my work well
I have confidence in the senior management team
I have confidence in the trustee board
If a friend or relative needed treatment I would be happy with the standard of care provided
Diversity is valued at this charity
I am happy with the flexible working practices here
The key areas we wanted to focus on was the following;
Pay:
- Research external benchmarking (agenda for change and other children’s hospices across London)
- Review pay structures, bandings and salary comparisons internally
- A phased approach to addressing increases
- Look at affordability
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1923
Dealing with performance:
- Review the induction and objectives process for new starters to ensure performance in initial
months
- Managers training in setting objectives and managing performance and identifying training needs
- Review capability policy and procedure
Working hours:
- Initially set up focus groups in each area to identify challenges, pressures and issues to find out
more about what is causing long working hours
- Focusing on recruitment and staff retention
Communication between teams:
- Review meeting structures and purpose
- Setting up cross functional meeting that would be useful and could be set-up
- Review internal communications and how we are sharing information
Freedom to Speak Up Guardian
In response to concerns about culture in the National Health Service (NHS), the Secretary of State for
Health and Social Care commissioned Sir Robert Frances to carry out an independent review: Freedom to
Speak Up5. The review recommended that every NHS or healthcare organisation in the UK should provide
training on the value of speaking up which complies with the national standards. Hence, the creation of the
role ‘Freedom to Speak Up Guardians’ came into being.
This guardians are appointed locally and are expected to be both proactive and reactive on the purpose for
protecting patient safety and the quality of care, improve the work experience of all staff and promote
learning and improvement.
Richard House has an updated ‘Whistleblowing or Freedom to Speak Up’ policy and has appointed the
Quality Monitoring and Informatics Lead as the Freedom to Speak Up Guardian. Training was provided by
the CQC Head Office and is a member of the South East London guardian group.
5
https://www.cqc.org.uk/national-guardians-office/content/information-speaking (accessed 23 May 2019)
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1924
Accident and Incident Reporting
Richard House has recently adapted the use of electronic reporting to incident and accident – Vantage
sentinel technologies. The system is widely used in hospices and charities across England. The software
modules integrate all the data into one system where adding and finding any data reported is easy plus
online guidance from Vantage that makes it simple to learn and easy to use. The technology is compliant
with the National Reporting and Learning System (NRLS) from the National Patient Safety Agency (NPSA).
Further, Vantage sentinel technology plays a vital role in helping Richard House meet the mandatory
reporting regulations of the NRLS in identifying trends in patient safety, reduce risk and set out priorities
for best practice.
Below is the table presentation of our recorded incident and complaint reporting in 2018/19.
Measure Q1 Q2 Q3 Q4
Healthcare associated infections (MRSA and Clostridium difficile cases) 0 0 0 0
Complaints about issues relating to care: 0 1 0 2
The Director of Care and CEO managed all complaints relating to care and
spoke with families on the telephone, or had a face to face meeting to
discuss their concerns. Processes were updated and additional training
given whenever the investigation found this to be the appropriate response.
Incidents and Serious Incidents: 2 3 4 3
All but one of the incidents were ‘low’ or ‘very low risk’ and policy and
processes were followed. The moderate risk’ incident was discussed with
the CCG, LADO and CQC.
Medication Incidents: 6 7 7 8
All medication incidents recorded as ‘no harm’ Policy and processes were
followed and discussed with external pharmacy support at local and joint
Medicine Safety & Improvement meetings
Pressure ulcers (grades 1-4) 1 0 0 0
Only one grade 1 pressure ulcer incident was reported and followed up with
the family and the child’s careplan was adjusted with preventative measures
to be taken
Urinary tract infections in patients with a catheter 0 0 0 0
Venous thrombo-embolism (VTE). 0 0 0 0
Notification and subsequent reporting of CQC inspections and 0 0 0 0
recommendations
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1925
Consent
The Health and Social Care Act 2008 has set out Regulation 11: Need for consent6. It is to ensure that all
people using any healthcare services, and those lawfully acting on their behalf, have given consent before
any care or treatment is provided.
As a healthcare organisation, Richard House ensures that there is an updated policy and procedure
available for access to all staff and that staff involved are trained. We understand that children, young
people and parents need a valid, relevant, accurate, up-to-date, easily accessible and well-presented
information that is appropriate to their level of understanding, before they can decide whether to consent
to, or refuse treatment.
Also, Richard House ensures that consent is obtained lawfully and the staff who obtains the consent has
the necessary knowledge and understanding of the care and/or treatment that they are asking consent for.
We are 100% compliance with getting consent from service users and family.
Pressure ulcers
Richard House understands that pressure ulcer monitoring is a quality standard that covers the prevention,
assessment and management in all healthcare settings, including hospices and that it covers people of all
ages: neonates, infants, children, young people and adults (including older people)7.
Additionally, Richard House acknowledges the fact that all service users are potentially at risk for
developing a pressure ulcer. We ensure that all clinical staff conducts assessment on skin integrity on
admission and on a daily basis for all service users who are dependent. We have an updated policy on
tissue viability and works closely in coordination with East London tissue viability community group for
related concerns.
We had no pressure ulcer related incident.
Falls
Children fall as they grow, develop coordination and new skills and are often unaware of their limitations.
Therefore one could conclude that all children are at some risk for falling. It is therefore important to
discern between anticipated falls (may occur when a patient whose score on a falls risk tool indicates
6
https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulation-11-need-consent/accessed 13 May 2019
7
https://www.nice.org.uk/guidance/qs89/resources/pressure-ulcers-pdf-2098916972485/accessed 13 May 2019
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1926
he/she is at risk) and accidental trips, slips and falls. Where children and young people are at risk of falling,
a falls risk assessment is conducted. Richard House acknowledges the importance of maintaining a safe
environment for all service users and identifying those who are at risk of fall. To date, Richard House has 0
falls incident related to clinical activities especially to those service users who are bedbound and/or totally
dependent of our staff.
We had a total of 3 accidental falls and no incident of anticipated fall.
Information governance (General Data Protection Regulation - GDPR)
The legal framework governing the use of personal confidential data in healthcare is complex. It includes
the NHS Act of 2006, the Health and Social Care Act 2012, the Data Protection Act, the EU General Data
Protection Regulation (GDRP) and the Human Rights Act. NHS England8 stated that this law allows personal
data to be shared between those offering care services directly to patients but it protects patients’
confidentiality when data about them are used for other purposes. These “secondary uses” of data are
essential if an organisation is to run a safe, efficient and equitable health services.
Richard House’ privacy policy is available on our website and clearly set out how we collect and use
information lawfully and our compliance with GDPR. In addition, Richard House has an updated policy on
information governance and an E-safety policy that expresses our objective on the safe use of internet and
social media within our premises. All clinical and support staff underwent training, and information
governance related incidents are continuously monitored. The Director of Finance and Operations is the
lead person and point of contact on all information governance and GDPR related issues.
We had no information governance or GDPR related incidents.
8
https://www.england.nhs.uk/ig/about/accessed 15 May 2019
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1927
IV. Caseload Management
The Case Management Society of America (CMSA)9 defines it as a “collaborative process of assessment,
planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an
individual’s and family’s comprehensive health needs through communication and available resources to
promote quality cost-effective outcomes”. This definition suggest that, rather than being a single
intervention, caseload management refers to a package of care which covers a range of activities that
can vary widely between programmes.
In England, the Department of Health’s10 model for caring identifies caseload management as a key
strand for people with long term conditions.
We received 53 referrals in 2018/19 and accepted 44 of whom 6 subsequently passed away.
As part of our active eligibility review process, Richard House periodically reviews and closes those on
the caseload who have been inactive for a significant period of time or those who does not meet our
eligibility criteria anymore. Richard House works close with families before any close is finalised to
ensure the family can discuss their current needs and be referred on to more appropriate services.
Open caseload by gender and age in 2018/19
Female -
Male - children children and
Female –
Male – referrals and young young Total
Age referrals
accepted people people
accepted
supported supported
2 5
0 0 3
Newborn to 28 days
4 22 2 21 49
28 days - 4 years
41 95
3 49 2
5 years - 11 years
11 40
3 25 1
12 years - 15 years
0 20 0 13 33
16 years - 18 years
0 9 0 5 14
19 years - 21 years
0 1 0 4 5
22 years - 26 years
10 126 8 97 241
Total
9
http://www.cmsa.org/who-we-are/what-is-a-case-management/accessed 10 May 2019
10
Department of Health (2005a). Supporting People with Long Term Conditions. An NHS and social care model to support local innovation and integration. London: Department of Health. Available at:
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ DH_4100252 (accessed on 10 May 2019).
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1928
The table below shows the use of our services:
Care services Total
101
# of service users admitted to Richard House
# of step down from hospital to home cases 4
96
# of respite cases
8
# of end of life cases
# of hospice at home cases 15
# of expected deaths 18
# of unexpected deaths 0
Total 241
Richard House Children’s Hospice recognises that people with long term conditions and families who are
living with them have a varying intensity of needs and that care should be targeted accordingly. The
reason why Richard House has hospice at home and social, therapeutic and resource (STaR) services to
address these needs.
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1929
The table below shows the provision of our STaR services:
STaR services Total
17 hours
Bereavement support sessions
Remembering and debrief meetings with staff 10 hours
52 hours
Psychotherapy
38 hours
Group Dance and Movement Psychotherapy
Transition casework 150 hours
Music Therapy 240 hours
10 days
Family Days
10 trips
Sibling Trips
12 outings
Outings
Pamper days 3 days
Mums’ groups 12 monthly groups
Parent Forums 3 forums
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1930
V. Quality Improvement Initiatives
Internal clinical governance group
Medicine Safety and Improvement Group (MSIG)
Multi-disciplinary Team (MDT group)
Board level Clinical Governance and Quality Monitoring Committee (CGQMC)
The Internal Clinical Governance Group represent the local clinical senior staff and meets bi-
monthly to discuss on issues related to quality monitoring. Regular agenda includes clinical audit,
service evaluation, service user feedback survey, updates on policies and procedures, relevant
training for staff, issues in residential and hospice at home services, e.g. medicine, etc.
Medicine safety forms a significant part of the pharmacy service. Procedures that manage how
medicines are used from admission to discharge should be in place and review regularly in response
to changes in the law, reported incidents and observed practices of concern.
The MSIG meeting is spearheaded by the senior staff in care together with the pharmacist to raise
awareness and share learning from incidents with members of staff as a way to promote
improvement in medicines safety within the organisation, via staff education and information and to
implement incident prevention strategies based on current practice standards.
The MDT meeting led by the clinical case manager and Director of Family and Care Services are
created for the purpose of reviewing all new referrals and serves as a platform to discuss any current
issues that needs to be addressed on the proper caseload of service users.
The Clinical Governance and Quality Monitoring Committee (CGQMC) is established as a
committee by the Richard House Board of Trustees. Richard House Children’s Hospice has a responsibility
to life-limited children, young people and their families to develop and maintain a safe, high quality of care
and support to meet their physical, emotional and spiritual and everyday practical needs. The overarching
purpose of the CGQMC is to support Richard House in meeting this responsibility by ensuring that effective
clinical governance and quality monitoring is integral to the work of the hospice and that attention is given
to building a culture of continuous quality improvement.
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1931
VI. Priority Improvements
Review of our Improvement Priorities for 2018/19
Provide Care
We introduced the holistic STAR outcome based assessments early last year with the main goal to have a
clear understanding of each family’s individual circumstances and needs. This assist in offering services and
support to best suit their needs. We conducted STAR assessments on all new referrals and we are continuing
to introduce the assessment tool to all the families on our existing caseload. A total of 60 assessments has
been completed so far and the introduction of the assessments has been well accepted by the families,
allowing better engagement with the services offered.
Another goal of the STAR assessments is to collect sufficient data to evaluate the impact of our services on
the families we work with and is an ongoing project.
Transition services was offered to the group of 58 young people on our caseload. Transition support was
given to 10 young people on an individual base, ranging from assisting them in finding a suitable college and
respite unit, in transition from paediatric to adult clinics in healthcare and working in liaison with external
healthcare professionals, psychologists and social services.
“When we arrive at the hospice
she is always pleased to be there
and generally heads straight for
the sensory room. We can relax,
enjoy time as a family and get
some sleep, knowing she is safe
and being cared for by a
professional, fun, caring team.”
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-1932
Hospice at Home
We developed an outreach service to provide greater choice for families in the location of short breaks,
symptom management, step-down from hospital to home and end of life care, supporting access,
engagement and personalisation of services The Hospice at Home was a three month pilot study that was
carried out by six members of the Richard House Hospice care team. This included three palliative care
nurses and three play and care workers. The pilot offered an outreach service to families across the
boroughs of North East London.
The pilot commenced in January 2019 and due to demand the service is still continuing. The service was
provided to a total of 12-15 families and it has been clear from the feedback received through
questionnaires and telephone interviews that this is a service that is needed to improve quality of life and it
has been very beneficial to the families. Our aim is to develop the service further to reach more families
and those with higher complex needs.
“Hospice at Home has been a
lifesaver for us. It really has.”
Community engagement and involvement
We held 3 family forums in 2018/2019 and this allowed families to meet with the CEO and the Family and
Care Services teams. Families were updated on services, activities available developments such as the
addition of a 5th bedroom and the launch of the Hospice at Home service. The family forums was combined
with entertainment to the children on our caseload and their siblings.
Richard House Trust is a registered charity (1051029) and a company limited by guarantee (3232837 – England and Wales). Its registered address is Richard House Children’s Hospice, Richard House Drive, London E16 3RG. | Quality Account 2018-19You can also read
