North Devon Hospice's Quality Account 2015-2016

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Quality Account 2015-2016

Contents

1. Quality Statement

01

2. Performance in 2015-2016

04

3. Priorities in 2016-2017

21

4. Statements of Quality Assurance

23

5. Referrals

26

Crosscare

North Devon Hospice Quality Account 2015-16

01

1. Quality Statement Dear colleagues, Making a referral to us, as early as possible, is a key theme for the years ahead. Although we have made significant leaps forward in improving access to our care and support, we continue to rely heavily on you, our healthcare partners, to refer your patients and their families as early as possible so we can be there for the entirety of their journey.

During the last year our (biggest) milestone has been opening our first outreach centre in Holsworthy, The Long House. Having this facility on the doorstep of the community means that patients and their families from the surrounding area have better access to our support services, negating the need for a 2 hour round trip to our main hospice base in Barnstaple. In addition to The Long House, we have also expanded our Hospice to Home team, meaning we have been able to provide more care, round the clock, in people’s own homes. We have also provided record numbers of educational opportunities for local health professionals.

For the year ahead we remain committed to providing more care and support closer to people at home, but we need your early referrals to ensure local patients and families can access as much of our care and support as early in their journey as possible. We will continue to work closely with care establishments to ensure we achieve quick and smooth referrals.

I very much look forward to working with you in the coming year.

Murray Fletcher

Medical Director and Consultant in Palliative Medicine murrayfletcher@northdevonhospice.org.uk

1. Quality Statement

Kind regards,

02

North Devon Hospice Quality Account 2015-2016

Strategic Objectives: A. Enhance community based care to improve patient and carer access

To seek to ensure hospice care is accessible and responsive to individual patient needs

To develop services closer to a patient’s home

B. To further attract, engage and develop our staff and volunteers to enhance care

To recruit, retain and develop staff

To recruit, retain and develop a robust network of volunteers supporting all aspects of our work

C. To broaden, improve and enhance services to meet the future needs of our beneficiaries

To build partnerships to enhance our care

To tailor and develop models to meet the future needs of our beneficiaries

D. To enhance the knowledge and skills of our partners involved in End-of-Life Care

To be the centre of excellence for End-of-Life Care education

1. Quality Statement

E. Financial sustainability to meet the needs of our beneficiaries

Increase income available for charitable expenditure

being there for all the family

.

www.northdevonhospice.org.uk

North Devon Hospice Quality Account 2015-16

03

Our Values We believe in: • • • • •

Being there for all the family Recognising and treating each person as an individual The caring and clinical support that is provided The sense of safety and support the hospice brings The expertise of our professional teams.

Mission Statement Our mission is to promote the relief of symptoms amongst people with life-limiting illnesses.

We do this through offering: • Specialist palliative care for patients with an advanced, progressive illness and support for the adults and children who are close to the patient • Personal care to patients at the end-of-life and support to their families at home and in other settings • Supportive care to patients who have been diagnosed with a life-limiting illness and to the adults and children who are close to the patient

Health Professionals Helpline 01271 347214

.

for palliative care advice and information

1. Quality Statement

• Advice, support and education provision to patients, families, communities, organisations and healthcare professionals who are responding to life-limiting illness, death and loss.

04

North Devon Hospice Quality Account 2015-16

2. Performance in 2015-16 •

We have recruited additional Multi-Skilled Healthcare Assistants to join our Hospice to Home team. This has enabled us to provide more care and support in people’s own homes throughout the day and night

•

We have continued to request feedback on our services through the ‘I Want Great Care’ national survey programme. We also have improved the ways in which people can give feedback www.iwantgreatcare.org.uk

We value your opinion We value your opinion. Please give us your feedback on our care and support by completing a questionnaire at www.iwantgreatcare.org

iWantGreatCare We have improved access to our care and support in the remote town of Holsworthy and surrounding area. In September 2015 we opened our first outreach centre, The Long House.

2. Performance in 2015-2016

•

being there for all the family

.

www.northdevonhospice.org.uk

North Devon Hospice Quality Account 2015-16

Health Professionals Helpline 01271 347214

2. Performance in 2015-2016

• One-to-one support for patients • One-to-one support for family members • ‘It’s Wednesday’ weekly drop-in • The Carers’ Group • Bereavement Support Group • The Patients’ Support Group • Complementary Therapies • Outpatient appointments

05

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for palliative care advice and information

06

North Devon Hospice Quality Account 2015-16

Overview of Clinical Governance We pride ourselves on providing people focused care, of the highest standard. We monitor our efficiency and effectiveness through quality control audits.

Clinical Audits • • • • • • •

2. Performance in 2015-2016

• • • • • • • •

I Want Great Care Patient & Carers Focus Group Review Carers Support Needs Assessment Tool Controlled Drugs Medicines Management Hand Hygiene Infection Control Clinical Care Environment Preferred Priorities for Care Documentation Single Point of Access Document Scanning Nutritional Clinical Supervision Management of Terminal Agitation Effectiveness of Hyoscine in Reducing Secretions in Terminally Ill Patients Safe Disposal of Sharps

being there for all the family

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• • •

South West Hospices Informatics Project: Medication Errors, Falls and Pressure Damage South West Hospices Regional Preferred Place of Care for the Dying Help the Hospice National Medication Errors, Falls and Pressure Damage.

Learning Points • • • • • • • • •

Management of Complex Pain Opioid Switching Use of Co-analgesics GI Obstruction Prescribing in Renal Failure Management of Nausea and Vomiting Ethical Challenges of Nutrition and Hydration Clinical Decision-making avoiding Errors Aromatherapy in Palliative Care.

Significant Event Meeting • • •

www.northdevonhospice.org.uk

Care and Support of Patients Talking of Suicide Challenges of Severe Breathlessness Discharge Review.

North Devon Hospice Quality Account 2015-16

07

Hospice Education Our specialist clinical and care teams have facilitated a range of education courses throughout the year. With specialist knowledge in specific areas and an up-to-date understanding of practice, the facilitators were best placed to provide quality education and information.

TRAINING Total number of healthcare professionals trained

1,063

Total number of care home staff who received tailored end-of-life care training specifically for care homes

579

% of positive feedback

99%

Health Professionals Helpline 01271 347214

.

for palliative care advice and information

2. Performance in 2015-2016

Book courses online at www.northdevonhospice.org.uk

08

2. Performance in 2015-2016

EDUCATION COURSES

NORTH DEVON HOSPICE Facilitators and contributors

HEAD 303 Enhancing Palliative and End-of-Life Care University Degree Module

Clinical Nurse Specialist Team (CNS), Supportive Care, Consultant in Palliative Care/Director of Medical Services, Medical Officers and the Head of Education. External contributors included the Consultant in Psychiatry (Devon Partnership Trust) and Oncology (NDHT)

NCFE Level 3 Principles of End-of-Life Care

The Head of Education and the Care Home Facilitator

Six Steps Training (Accredited Course)

Consultant in Palliative Care/Director of Medical Services, Medical Officers, CNS, In-Patient Unit Nurses, Head of Education and the Care Home Facilitator

Six Steps Group Forum

The Head of Education and the Care Home Facilitator

Trust Training - Advance Care Planning and Communication Study Day

CNS and the Head of Education

Trust Training - Symptom Management and Care of the Dying Study Day

CNS and the Head of Education

Advance Care Planning & Communication Skills in End of Life Care Study Day

CNS, Care Home Facilitator and the Head of Education

Bereavement, Loss and the Impact of Life-Limiting Illness Study Day

The hospice Chaplain, Supportive Care and the Head of Education

Care of the Dying Study Day

CNS, In-Patient Unit Nurses and the Head of Education

Communicating Effectively in Healthcare Study Day

CNS, Care Home Facilitator and the Head of Education

Dementia Study Day

The Head of Education. External contributors included Dementia Friends representative, Alzheimer’s Society representative, Community Matron, Specialist Dementia Domiciliary Care Manager, Specialist Nursing Home Dementia Manager

Dilemmas in Palliative Care Study Day

Consultant in Palliative Care/Director of Medical Services and the Head of Education

Symptom Management Study Day

CNS and the Head of Education. External contributors included Endof-Life Lead & Living With and Beyond Cancer Project Nurse (NDHT)

Symptom Management and Care of the Dying Study Day

CNS, In-Patient Unit Nurses and the Head of Education

Outreach Training - Bereavement and Loss Study Session

Supportive Care, CNS and the Care Home Facilitator

Outreach Training - Care in the Last Days of Life Study Session

Care Home Facilitator

Outreach Training - Communication Study Session

CNS, Care Home Facilitator and the Head of Education

Outreach Training - Discussions as the End of Life Approaches Study Session

Care Home Facilitator

Syringe Driver Training Session

In-Patient Unit Nurses, CME Medical Manager, Care Home Facilitator, CNS

Care Home Forum

Care Home Facilitator

North Devon Hospice Quality Account 2015-16

09

Overview of our Case Load

We cared for and supported thousands of people during the year. Our care and support extends beyond our patients and reaches out to their family members, their carers and their children. We believe in being there for all the family.

Every person we have supported was affected by a life-limiting illness and many people received more than one service. Not all of our patients had cancer, we also supported people with other life-limiting illnesses such as MND and liver failure, among others.

NEW REFERRALS AND RE-REFERRALS 802

Family Members/Carers

365

Total number of patients and carers supported

Health Professionals Helpline 01271 347214

1,167

.

for palliative care advice and information

2. Performance in 2015-2016

Patients

10

North Devon Hospice Quality Account 2015-16

PATIENT AGE PROFILE % 0.0

61-70

20.7

17-20

0.0

71 - 80

32.4

21-30

0.5

81-90

23.5

31-40

1.0

91-101

7.0

41-50

5.2

Unknown

0.2

51-60

9.5

2. Performance in 2015-2016

0-16

being there for all the family

.

www.northdevonhospice.org.uk

North Devon Hospice Quality Account 2015-16

“

11

North Devon is extremely lucky to have this facility. My father was treated with the utmost respect and dignity.The staff are exemplary. On his passing we could not have asked for better treatment for both him and us.Thank you.

“

A FAMILy MEMBER, VIA WWW. I WANTGREATCARE.ORG

PLACE OF DEATH Home

286

Hospice

103

Acute Hospital

69

Care Home

67

Community Hospital

24

Other

3

2. Performance in 2015-2016

Health Professionals Helpline 01271 347214

.

for palliative care advice and information

12

North Devon Hospice Quality Account 2015-16

Clinical Nurse Specialist Service Our hospice nurses supported 989 patients last year. The vast majority of their support was provided in the privacy and comfort of the patient’s own home.

All professional referrals are triaged by the CNS team and, as standard, the referrals are responded to within 24 hours. In addition to the one-to-one support delivered in the community, the team also made nearly 10,000 phone calls to facilitate the delivery of individualised patient care.

LOCATION OF VISITS

3500

Care Home/Nursing Home

Number of patient visits

3000

Hospice (Deer Park)

2500

Home 2000

Hospital

1500

The Long House

2. Performance in 2015-2016

1000 500

being there for all the family

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www.northdevonhospice.org.uk

North Devon Hospice Quality Account 2015-16

13

Hospice to Home Service

The Hospice to Home service plays a vital and essential role in end-of-life service provision across North Devon. The rapid response team have supported patients and families at home, avoiding an unnecessary admission into hospital, which continues to save NDDH a significant sum of money.

83% of people achieved their preferred place of care.

PATIENTSĂ• PREFERRED PLACE OF CARE

Health Professionals Helpline 01271 347214

.

90%

Hospice

8%

Care Home

2%

for palliative care advice and information

2. Performance in 2015-2016

Home

14

North Devon Hospice Quality Account 2015-16

The Bedded Unit There was a total of 144 admissions to the Bedded Unit last year, some of which were later re-admitted for further care.

90% of our patients had a cancer diagnosis, with the remaining 10% being referred for other life-limiting conditions such as MND and liver failure.

A large proportion of patients were ‘at home’ before being admitted. This is representative of the extensive amount of care we were providing in people’s own homes, especially the Hospice to Home service.

PATIENT’S LOCATION BEFORE BEING ADMITTED PatientÕ s own home

118

2. Performance in 2015-2016

Acute Hospital/Community Hospital Care Home/Nursing Home

25 1

Total 144

being there for all the family

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www.northdevonhospice.org.uk

North Devon Hospice Quality Account 2015-16

15

DISCHARGES Died

98

PatientÕ s own home

34

Care Home or Nursing Home

12

Acute Hospital/Community Hospital

0

Total number of discharges

144

A significant part of our work on the Bedded Unit includes offering support and guidance for family members and those who are close to our patients. We meet people at a difficult time in their life and the support given by our nurses and healthcare assistants continues to provide comfort to those they meet.

2. Performance in 2015-2016

Health Professionals Helpline 01271 347214

.

for palliative care advice and information

16

North Devon Hospice Quality Account 2015-16

Occupational Therapy and Physiotherapy

Last year we continued to provide occupational therapy as part of our discharge planning process and to support patients in maintaining a level of comfort and independence whilst at the hospice and in their own home.

2. Performance in 2015-2016

Home visits

Hospice

Total

Occupational Therapy

6

289 295

Physiotherapy

6

239 245

being there for all the family

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www.northdevonhospice.org.uk

North Devon Hospice Quality Account 2015-16

17

Supportive Care Services In addition to the clinical care we provide, we also offer emotional and spiritual support to people who have been affected by a life-limiting illness. As well as supporting our patients, we also provide emotional support to family members, including young children.

Last year our Supportive Care services continued to be there for all the family, supporting 1,167 people.

INDIVIDUALS SUPPORTED Patients

378

Family members

789

Total supported

1,167

2. Performance in 2015-2016

Health Professionals Helpline 01271 347214

.

for palliative care advice and information

18

North Devon Hospice Quality Account 2015-16

In all cases, it is important that we receive referrals as early as possible. Our supportive care services can be available from the moment a person or a family hears the news. Accessing our care and support early means that people can be supported throughout the duration of their journey.

Pre-bereavement support We offered a range of pre-bereavement support. There was a total of 2,466 attendances. The breakdown of services provided included:

2. Performance in 2015-2016

• • • • • •

One-to-one support ‘It’s Friday’ weekly drop-in The Carers’ Group The Patients’ Group Special events/taster days Supportive phone calls

Bereavement support We offered a range of bereavement support services, which totalled 1,153 attendances. The breakdown of services provided included: • • •

One-to-one support The Bereavement Support Group Supportive phone calls

being there for all the family

.

www.northdevonhospice.org.uk

North Devon Hospice Quality Account 2015-16

19

Day Hospice

NUMBER OF DAy HOSPICE PATIENTS

46

Number of these patients with a cancer diagnosis

34

Number of these patients with another diagnosis

12

46 patients repeatedly attended Day Hospice throughout 2015-16, totalling 635 attendances.

Day Hospice is a good opportunity for patients to socialise in the comfort of a supportive environment, as well as accessing additional care and support at different times during their journey.

2. Performance in 2015-2016

Health Professionals Helpline 01271 347214

.

for palliative care advice and information

20

North Devon Hospice Quality Account 2015-16

Complementary Therapies We offer a range of complementary therapies for patients and their carers.

Studies indicate therapies can help to aid relaxation and sleep and enhance well-being. Attending therapies and group sessions also gives people an opportunity to access additional services in the comfort of a supportive environment.

92 complementary therapy sessions were delivered from our new outreach centre in Holsworthy, The Long House. This is a completely new service that has been in operation since September 2015.

COMPLEMENTARy THERAPy SESSIONS Aromatherapy

22%

Bowen Technique

15%

Carers Pamper Day

9%

Feldenkrais

9%

Indian Head Massage

1%

Reflexology Massage Look Good Feel Great

2. Performance in 2015-2016

Gents Event Therapies from The Long House

being there for all the family

.

www.northdevonhospice.org.uk

10% 4% 11% 4% 15%

North Devon Hospice Quality Account 2015-16

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3. Priorities in 2016-2017 • To deliver care closer to home across North Devon through the further development of our Hospice to Home team • To increase the level of understanding, awareness of, and access to, our care and services for GPs and District Nurses • To increase end-of-life care skills and knowledge of healthcare partners across North Devon particularly in nursing and care homes.

3. Priorities in 2016-2017

Health Professionals Helpline 01271 347214

.

for palliative care advice and information

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North Devon Hospice Quality Account 2015-16

Thank you We rely on support from the local community, so we can continue providing specialist care and support for local families when they need us.

We need to raise over ÂŁ4 million every year, from scratch, to be able to provide our care and support year on year. We can only do this thanks to regular donations, fundraising events, donations to our charity shops and because of the gifts that people leave us in their wills.

On behalf of every patient and family member we have supported during the last year, thank you for your continued support.

To make a donation, please contact Ali Hunt, Head of Fundraising: alihunt@northdevonhospice.org.uk / 01271 347206

Comments and Feedback

3. Priorities in 2016-2017

If you have any comments or questions about this Quality Account or our services in general, we are always grateful to have feedback. Please do not hesitate to contact us: Rachel McCarty Director of Care and Registered Manager North Devon Hospice Deer Park Newport Barnstaple North Devon EX32 0HU rachelmccarty@northdevonhospice.org.uk / 01271 347203

being there for all the family

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www.northdevonhospice.org.uk

North Devon Hospice Quality Account 2015-16

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4. Statements of Quality Assurance The Board of Trustees continue to maintain high quality standards of care whilst also supporting the expansion of our care and support in our remote and rural catchment area.

The Board’s dedication to improving access to our services was evident in their investment in our first outreach centre, The Long House. We opened the doors to The Long House in September 2015 and, ever since, have provided more care and support, closer to people in Holsworthy and the surrounding areas.

Statements of quality assurance from the Board of Trustees are available overleaf.

www.northdevonhospice.org.uk

4. Statements of Quality Assurance

.being there for all the family .

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North Devon Hospice Quality Account 2015-16

In compliance with statutory regulations, North Devon Hospice’s Board of Trustees can confirm: 1.1 During 2015-2016 North Devon Hospice provided or sub-contracted no NHS Services directly. A grant was received from the new Clinical Commissioning Group to provide palliative and end-of-life care.

1.2 During 2015-2016, no National Clinical Audits and no National Confidential Enquiries covered NHS services that North Devon Hospice provides.

1.3 The reports of eighteen clinical audits were reviewed by North Devon Hospice in 2015-2016 and North Devon Hospice will take action to continue improving the quality of healthcare provided.

1.4 The number of patients receiving NHS services provided or sub-contracted by North Devon Hospice in 2015-2016 that were recruited during that period to participate in research approved by a research ethics committee was zero.

1.5 North Devon Hospice’s income in 2015-2016 was not conditional on achieving quality improvement and innovation goals through the Care Quality Commission.

4. Statements of Quality Assurance

1.6 North Devon Hospice is required to register with the Care Quality Commission and its current registration status is active.

We are active in the following areas: • Treatment of disease disorder and injury • Caring for adults under 65 years • Caring for adults over 65 years.

1.7 The Care Quality Commission has not taken enforcement action against North Devon Hospice during the reporting period of 2015-2016.

1.8 North Devon Hospice has not participated in any special reviews or investigations by the Care Quality Commission during the reporting period.

being there for all the family

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www.northdevonhospice.org.uk

North Devon Hospice Quality Account 2015-16

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1.9 North Devon Hospice did not submit recordings during 2015-2016 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics which are included in the latest publication data.

1.10 North Devon Hospice was not subject to the Payment by Results Clinical Coding Audit during 2015-2016 by the Audit Commission.

“

She wanted to stay at home with us. After so many appointments, it was nice to just be and be together at home

www.northdevonhospice.org.uk

“

.being there for all the family .

4. Statements of Quality Assurance

A FAMILy MEMBER WHO RECEIVED HOSPICE TO HOME SUPPORT

26

North Devon Hospice Quality Account 2015-16

5. Referrals

Refer early Referring your patients and/or their family members early ensures they can access a wide range of care and support services, at various points throughout their journey. In addition, it can help to negate the volume of support related visits to their own GP. We respond to all clinical referrals within 24 hours and supportive care referrals within 5 working days.

Call us

01271 344248

Fax

01271 347218

Internal mail letter

CNS team

5. Referrals

being there for all the family

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www.northdevonhospice.org.uk

North Devon Hospice Quality Account 2015-16

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Clinical Nurse Specialist (CNS) Service To provide a specialist palliative care community nursing service for adult patients with complex problems associated with life-limiting illnesses, when the needs of the patient and family are unable to be met by the generalist palliative healthcare professionals in the care setting.

Available to people who • Have an advanced, progressive illness or are on the Gold Standards Framework • Need advice and care for pain management and other distressing symptoms • Would benefit from holistic care, with any emotional and spiritual needs being addressed.

This includes • Clinical Nurse Specialists providing advice and support to patients and families in the care setting of their choice • The hospice multi-disciplinary team sharing care, information, advice and support with other health and social care professionals • Telephone advice • A named contact for each patient • 24 hour advice line for local professional colleagues; provided by the hospice in-patient unit.

Make a referral Write a letter or fax the ‘request for services’ referral form, or call 01271 344248.

Whilst healthcare professionals can request community nursing services, the patient’s GP must give their agreement on all occasions. Acceptance is reviewed during the daily (Monday to Friday) referral team meetings.

5. Referrals

Health Professionals Helpline 01271 347214 . for palliative care advice and information

28

North Devon Hospice Quality Account 2015-16

The Bedded Unit (IPU) To provide specialist palliative care in-patient services for adult patients who have complex problems associated with life-limiting illnesses.

Available to people who • • •

Have an advanced progressive illness Need treatment for complex pain management or other distressing symptoms Have complex end-of-life care needs.

This includes • • • • •

24 hour care in a purpose built 7 bedded unit to help with the management of complex symptoms or in providing end-of-life care Allied Healthcare Professionals providing one-to-one and group sessions Consultant Out-patient Treatments and Consultant Domiciliary Appointments The hospice multi-disciplinary team sharing care, information, advice and support with other health and social care professionals A family room and overnight stay room for relatives.

Make a referral Write a letter or fax the ‘request for services’ referral form. In urgent and out-of-hours cases, call the Duty Medical Officer direct on 01271 347214.

5. Referrals

All requests must be with the explicit agreement of the GP and/or relevant hospital Consultant. Acceptance of admissions 24/7 as appropriate.

being there for all the family

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www.northdevonhospice.org.uk

North Devon Hospice Quality Account 2015-16

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Supportive Care Services To provide a range of supportive care services, pre and post bereavement, to patients, carers and family members, including children.

Available to people who • • •

Are over 18 and have a life-limiting illness Are adults or children deeply affected by a person’s illness Are left bereaved as a result of that person’s death.

This includes •

• • •

Support groups for patients, for carers and also the bereaved, either one-to-one or in a group session Day Hospice ‘Look Good Feel Great’ sessions 'It’s Friday’ drop-in

• • • • • • •

Complementary therapies ‘Carers Pamper Day’ One-to-one bereavement support Support for children and their carers Pastoral and spiritual support Creative arts ‘One off’ events in response to client needs.

Make a referral Completion of the ‘request for services’ referral form. Requests can be made from GPs, Consultants, Social Services, other hospices and other agencies. Requests are considered at any point in the patient’s/family’s journey and acceptance is reviewed during the daily (Monday to Friday) referral team meetings.

5. Referrals

Health Professionals Helpline 01271 347214 . for palliative care advice and information

30

North Devon Hospice Quality Account 2015-16

Hospice to Home Service To support patients and their families living with a life-limiting illness, to provide care and support as a short-term intervention to help prevent a crisis escalating or to avoid an acute admission.

Available to people who • • • •

Are over 18 and have a life-limiting illness Are known on the Gold Standards Framework register Have a care plan and risk assessment Require care to prevent admission to hospital or another care setting.

This includes • • • •

Hands on end-of-life care, palliative care and support in the community Crisis intervention to prevent an unplanned admission to hospital Skilled carers to provide round the clock care for those at the end of life, day or night To facilitate rapid discharge from hospital to their preferred place of care.

Make a referral

5. Referrals

Referrals are usually made by telephone between 8am and 8pm. Via the phone during office hours (Monday to Friday) by calling 01271 347246 or 347247.

Out-of-hours contact via Community Nurses on 01392 823666.

Referrals are accepted from all healthcare professionals. The service excludes routine packages of care and does not provide respite care.

being there for all the family

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www.northdevonhospice.org.uk

North Devon Hospice Quality Account 2015-16

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Where are we We have been providing care for over 30 years. The majority of our care is provided in peopleÕ s own homes.

In addition to the care and support we provide throughout the community, we have teams and services based at two locations.

The Long House Holsworthy

Deer Park Barnstaple Our main site is called Deer Park and is based on the outskirts of Barnstaple. At Deer Park, our patients and their families can access a wide range of care and support services, which includes visiting the Bedded Unit.

North Devon Hospice The Long House Dobles Lane Holsworthy North Devon EX22 6GH Tel: 01271 344248

Health Professionals Helpline 01271 347214 . for palliative care advice and information

5. Referrals

North Devon Hospice Deer Park Newport Barnstaple North Devon EX32 0HU Tel: 01271 344248

The Long House opened its doors in 2015 thanks to fundraising throughout the local community.

This purpose built outreach centre is adjacent to the Holsworthy Medical Centre in Holsworthy. Patients and their families can access a range of supportive care services including one-to-one support, group support and complementary therapies.

EXAMPL E R E FE R R AL F OR M

Call 01271 344248 . Fax 01271 347218 . Internal Mail - CNS Team North Devon Hospice, Barnstaple, North Devon EX32 0HU

www.northdevonhospice.org.uk

being there for all the family

request for services P L E A S E FA X B OT H S I D E S O F T H I S F O R M TO 0 1 2 7 1 3 4 7 2 1 8 PLEASE USE CAPITAL LETTERS Use this form if the person referred: u has a diagnosis of a life-limiting illness OR is a family member or friend of the above OR has been bereaved

u is currently in need of support u is in agreement with the referral

I AM REFERRING THIS PERSON TO NORTH DEVON HOSPICE BECAUSE:

DETAILS OF PERSON BEING REFERRED Title:

Name:

Male q Female q

Address: Post Code: Telephone: Age:

DOB:

NHS Number:

Religion:

Occupation:

Person lives alone: Yes q

No q

Person has dependants: Yes q No q

Next of kin Title:

Name:

Address: Telephone: Relationship to the person who is ill: Location of person on referral (if different from address above):

Is the GP/Consultant aware of this request for hospice services? Yes q

No q

This person is: A patient q GO TO SECTION A A Carer/Family member/other (please specify):

q GO TO SECTION B

P.T.O

EXAMPL E R E FE R R AL F OR M

Call 01271 344248 . Fax 01271 347218 . Internal Mail - CNS Team P L E A S E FA X B OT H S I D E S O F T H I S F O R M TO 0 1 2 7 1 3 4 7 2 1 8 A. COMPLETE THIS SECTION IF THE PERSON BEING REFERRED IS A PATIENT Patient Name: Diagnosis:

Date of diagnosis:

Other significant diagnoses:

The patient’s clinical team GP:

District Nurse:

GP Practice:

Other Professionals:

Consultant:

Key Worker:

Prognosis:

Life Expectancy:

Gold Standards Framework: Yes q

No q

Preferred Priorities for Care discussed: Yes q

If Yes, are they: Red q

Amber q

Green q

No q

Advance Care Planning documentation completed: Yes q

No q

Main carer’s details Title:

Name:

Address: Telephone: Relationship to the person who is ill: B. COMPLETE THIS SECTION IF THE PERSON BEING REFERRED IS A CARER OR FAMILY MEMBER Name: What is the relationship to the person who is ill (or who has died)?

Is this person known to any other health professional? If so, please give details: If under 16, is the parent/guardian aware of this referral? Yes q No q Please include the name and address of the parent/guardian if under 16: Title:

Name:

Address: Telephone: REFERRER’S DETAILS Role: GP q District Nurse q Consultant q Specialist Nurse q Social Services q Teacher q Other agency: Title:

Name:

Address: Telephone:

Referrer’s Signature:

Mobile:

Date:

FOR INTERNAL USE ONLY Date and time request received: Referral taken by: Date discussed at referral meeting: Action:

Referral meeting outcome code:

h s n alt onal tio e H ssi ne 4 forma 1 i ofe elpl 472 and in r P H 3 ce 1 i 27 re adv 1 0 e ca

Working in the homes of our patients across the community

tiv llia a p for

Combe Martin

Working with GP practices & District Nurses

Woolacombe

Working with Nursing Homes & Residential Homes Working with Hospitals & Community Hospitals

Ilfracombe

N O R T H D E V O N

Braunton

Heanton

North Devon Hospice Deer Park

Chelfham

Barnstaple

The Long House

Instow

Landkey Swimbridge

Northam Abbotsham

Bideford

South Molton

Alverdiscott

Hartland Great Torrington

High Bickington

T O R R I D G E Chulmleigh

Bradworthy

Holsworthy

Shebbear Black Torrington Beaworthy

being there for all the family North Devon Hospice, Deer Park, Barnstaple, Devon EX32 0HU email: info@northdevonhospice.org.uk www.northdevonhospice.org.uk / 01271 344248 Registered charity no. 286554

Lynton