Quality Account 2018-2019 - Our Performance, Our Initiatives, Our Priorities

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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
Quality Account 2018-2019 - Our Performance, Our Initiatives, Our Priorities
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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
Quality Account 2018-2019 - Our Performance, Our Initiatives, Our Priorities
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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
Quality Account 2018-2019 - Our Performance, Our Initiatives, Our Priorities
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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
Quality Account 2018-2019 - Our Performance, Our Initiatives, Our Priorities
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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
Quality Account 2018-2019 - Our Performance, Our Initiatives, Our Priorities
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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
Quality Account 2018-2019 - Our Performance, Our Initiatives, Our Priorities
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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
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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
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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 2018-19
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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 2018-19
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          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 2018-19
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                        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 2018-19
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         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 2018-19
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     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 2018-19
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                                                          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 2018-19
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                                                                                                        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 2018-19
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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 2018-19
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              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 2018-19
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                    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 2018-19
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                            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 2018-19
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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 2018-19
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              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 2018-19
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                  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 2018-19
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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 2018-19
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         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 2018-19
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                                                            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 2018-19
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    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 2018-19
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     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 2018-19
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     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 2018-19
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                          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 2018-19
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