St Richard's Hospice Patient Services Report and Quality Account 2017-18

Patient Services Report and Quality Account 2017-2018

A review of the year, detailing our services for patients and those important to them.

Email Care Quality Lead Tracey.Grint@strichards.org.uk 01 90 5 7 63 96 3

enquiries@strichards.org.uk

www.strichards.org.uk St Richard’s Hospice, Wildwood Drive, Worcester WR5 2QT Registered charity number 515668 Registered company number 01850502

TABLE OF CONTENTS Mission Statement ................................................................................................................. 2 Part 1 ..................................................................................................................................... 2 Chief Executive’s Statement .............................................................................................. 2 Priorities for Improvement 2018-2019 ................................................................................ 2 Future planning .................................................................................................................. 3 Priorities for improvement 2017-2018 ................................................................................ 3 Summary of achievements ................................................................................................. 3 Part 2 ..................................................................................................................................... 4 Statement of Assurance from the Board ............................................................................ 4 Review of services ............................................................................................................. 4 Participation in clinical audits ............................................................................................. 5 Research ............................................................................................................................ 5 Quality Improvement and Innovation goals agreed with our Commissioners ..................... 5 What others say about us .................................................................................................. 5 Data Quality ....................................................................................................................... 6 Our Commitment to Clinical Quality, Patient Safety and Dignity ........................................ 6 Part 3 ..................................................................................................................................... 9 Quality and Performance Review ....................................................................................... 9 Medical Team..................................................................................................................... 9 Patient and carer feedback ................................................................................................ 9 Clinical Nurse Specialist Team......................................................................................... 10 Patient and carer feedback .............................................................................................. 12 Hospice at Home Team ................................................................................................... 12 Patient and carer feedback .............................................................................................. 14 In-patient Unit ................................................................................................................... 14 Patient and carer feedback .............................................................................................. 18 Family Support Service .................................................................................................... 18 Day Services and Outpatient Clinics ................................................................................ 25 Day Services evaluation feedback ................................................................................... 28 Occupational Therapy ...................................................................................................... 28 Physiotherapy .................................................................................................................. 29 Education and Resource Centre ...................................................................................... 30 Chaplaincy Team and Spiritual Care................................................................................ 32 Patient and carer feedback .............................................................................................. 32 Volunteer Services ........................................................................................................... 33 Community Engagement .................................................................................................. 34 Funding our Care ............................................................................................................. 34 Our Core Values .............................................................................................................. 36 Governance structure – November 2017 ......................................................................... 37 What Worcestershire Clinical Commissioning Groups say about St Richard’s Hospice .. 38 What Healthwatch Worcestershire says about St Richard’s Hospice............................... 39 Addendum ........................................................................................................................ 40

1

MISSION STATEMENT The mission of St Richard’s is, in partnership with other providers, to enhance through specialist palliative and end of life care and education, the quality of life of patients and those important to them, living with life-limiting illnesses.

Part 1 CHIEF EXECUTIVE’S STATEMENT PRIORITIES FOR IMPROVEMENT 2018-2019 2017/2018 has been a year of continued expansion and clinical innovation as outlined in this Quality Account. Building work has commenced on our re-configured Reception and Day Hospice extension and we are looking forward to the completion of this building work in 2019.

The transformation of our Day Hospice model of care and the new, expanded multi-purpose space will enable our clinical teams and volunteers to support more people to ‘live well’ with their life-limiting illness. This approach will enable people we care for to gain confidence in managing their conditions supported by a range of self-care strategies tailored to meet their personal needs and preferences.

The care of patients and their loved ones continues to be at the heart of everything we do.

Every day of the year our staff and volunteers strive to provide the highest standard of care, support and compassion for everyone using our services, in order for them to experience incredible care as reflected in this thank-you letter: “It is difficult to find the words to express our thanks for the incredible care, which our Mum and family received. She was admitted on a sunny Wednesday afternoon and treated by staff like the most precious person on the planet from the start to the finish of her time with you.

The setting, ambience and care were outstanding and it felt like a little Eden, a bubble, which we did not want to leave.

The staff judged each day so well and knew exactly when to give us space as a family and when to come in. There was always someone nearby to help us when we needed advice, help or medication for our Mum. The fact that we could sleep in the room with her, or in the guest room, made an enormous difference and we will be forever thankful for that opportunity.

As a family, we will feel forever connected to the hospice and will endeavour to do our part to raise further funds to support the essential, life-changing work which you do”.

We are fortunate to have staff and volunteers who continually strive to innovate and improve care and clinical services, as outlined in this report. We highly value our clinical relationships and partnership working with Health and Social Care providers, Primary Care and NHS Commissioners in Worcestershire. Working in partnership enables us to work together to provide a co-ordinated approach to care provision to best meet the needs of patients and their loved ones.

2

To the best of my knowledge, the information reported in this Patient Services Report and Quality Account is accurate and a fair representation of quality of healthcare services provided

by St Richard’s Hospice. The safety, experience and outcomes for all our patients and those dear to them are of paramount importance to us. We continue to actively seek the views of our service users.

FUTURE PLANNING It must be noted that implementation of these priorities is dependent upon the ability to raise the necessary funds.

Improvement Priority 1: Complete building project for re-configured Reception, Day Hospice and upper floor extension.

Improvement Priority 2: Complete the implementation of the Information Technology infrastructure project in order to improve IT connectivity and develop innovative IT solutions to support patient care and education.

Improvement Priority 3: Complete the workforce development project and identify workforce priorities, clinical skills and competencies to continually enhance the clinical care and services provided to patients and their loved ones.

Improvement Priority 4: Complete the service review of the In-patient Unit in order to identify areas to transform clinical care and patient experience.

PRIORITIES FOR IMPROVEMENT 2017-2018 (Taken from St Richard’s Hospice Patient Services Report and Quality Account 1st April 2016 – 31st March 2017) SUMMARY OF ACHIEVEMENTS Improvement Priority 1: Complete the Strategic Review implementation that will shape St Richard’s Hospice palliative and end of life care services for the next 5-10 years, including building an extension to Day Hospice.

Partially completed. Building work commenced in January 2018 Improvement Priority 2: Continue to expand the concept of wellness into practical rehabilitative palliative care to enable patients to live well with life limiting illness. Completed Improvement Priority 3: Continue to expand the Community Volunteers Service by recruiting and training more volunteers. Completed Improvement Priority 4: Take over the Worcestershire Palliative Care System contract for SystmOne and achieve interoperability with the GP system, EMISweb. Completed. Interoperability with GP systems continues to be under review.

3

Part 2 STATEMENT OF ASSURANCE FROM THE BOARD The following are a series of statements that all providers must include in their Quality Account. Many of these statements are not directly applicable to specialist palliative care providers.

REVIEW OF SERVICES Within the Quality Account guidance, hospices are required to report against those services commissioned by their local NHS. It might be helpful to clarify exactly how much of the hospice care services are commissioned by the three Worcestershire Clinical Commissioning Groups and the totality of what St Richard’s Hospice delivers.

Based on St Richard’s Hospice (The Provider) management accounts, funds from the grant agreement signed between them (The Commissioners) and St Richard’s Hospice during 2017/2018, accounted for 22% of the total income of St Richard’s Hospice. The totality of services St Richard’s Hospice makes available to the Worcestershire Clinical Commissioning Groups, using both NHS funding and its own charitable resources, is as follows:              

Patient Services Management Home care team of St Richard’s Nurse Specialists Hospice at Home Service Day Hospice (20 patients per day, 3 days/week), Living Well (currently 1 day per week for 30 patients) and Saturday Social 17 bed In-patient Unit for Specialist Palliative Care Family Support Services, including Counselling, Bereavement and Citizens Advice Bureau Advisor Medical Services Allied Healthcare Professionals Volunteer Services Education and Resources Centre Chaplaincy and Spiritual Care Outpatient facility for consultant-led clinics Hosts Worcestershire NHS Health and Care Trust Lymphoedema Service Facilitates management support for all services, especially the In-patient Unit 24/7, 365 days a year.

The detailed achievements of all St Richard’s Hospice Services, whether paid for by charitable or statutory funds can be seen in this report.

St Richard’s Hospice has reviewed all the data available to it on the quality of care in all of these services.

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PARTICIPATION IN CLINICAL AUDITS During 2017/2018, there were no requests to take part in national confidential enquiries covering NHS services relating to palliative care.

RESEARCH St Richard’s Hospice continues to be a research active hospice, in collaboration with the National Institute for Health Research Clinical Research Network: West Midlands.

The number of patients receiving NHS services provided or sub-contracted by St Richard’s Hospice 2017/2018 that were recruited during that period to participate in research approved by a research ethics committee was twenty eight. St Richard’s Hospice, in collaboration with University College London, is recruiting to the multicentre research study investigating the Prognosis in Palliative Care prognostic model alongside other prognostic scoring systems developed for patients with advanced cancer. Recruitment to the study began in November 2016 and ended on 31st April 2018.

QUALITY IMPROVEMENT AND INNOVATION GOALS AGREED WITH OUR COMMISSIONERS NHS South Worcestershire Clinical Commissioning Group did not issue any Quality Improvement Goals for this reporting period.

WHAT OTHERS SAY ABOUT US St Richard’s Hospice is required to register with the Care Quality Commission (CQC) and its current registration status is unconditional. The Care Quality Commission has not taken any enforcement action against St Richard’s Hospice during 2017/2018. The last on-site unannounced inspection took place on 14th and 15th March 2016, the overall rating for St Richard’s is ‘Good’.

On 5th April 2017 a planned Clinical Quality Review and Quality Assurance visit from NHS South Worcestershire Clinical Commissioning Group took place. Commissioners received an update on quality improvements across services and undertook a quality assurance visit within the In-patient Unit. In addition, they received assurance of infection prevention measures used at the hospice. The Commissioners spoke with staff, relatives of patients and patients. In view of the good assurance provided both at the meeting and review visit to the In-patient Unit the Commissioning Quality Assurance team agreed to move to a once yearly quality assurance review.

5

DATA QUALITY St Richard’s Hospice did not submit records during 2017/18 to the Secondary Users Service for inclusion in the Hospital Episodes Statistics which are included in the latest published data.

Information Governance Toolkit For 2017/2018 St Richard’s Hospice scored 66%, achieving level 2 in the Information Governance Toolkit. The submission is a requirement under the terms of our NHS Contract.

June Patel Chief Executive

OUR COMMITMENT TO CLINICAL QUALITY, PATIENT SAFETY AND DIGNITY Achievements in 2017/2018 St Richard’s Hospice continually strives to improve the standard of care experienced by patients and families. We pride ourselves on reviewing the quality of services delivered and in identifying and acting upon any areas that could be further improved. The monitoring of quality is undertaken by the Care Quality Sub-Committee which reports quarterly to the Hospice Services Committee, which is a sub-committee of the Council of Governors. The Care Quality Lead supports clinical staff in the measuring and reporting of clinical quality in their specialist areas. This enables an overview of standards of care across the whole organisation.

Care Quality Sub-Committee: its role in safeguarding clinical quality and safety Our continual review of quality of care provided is owned by the clinical teams and led by members of the Care Quality Sub-Committee, comprising of Clinical Heads of Department, Medical Director, two Governors, the Care Quality Lead and Care Development Lead.

For this reporting period the Care Quality Sub-Committee has: 

   

Received and reviewed content and trends outlined in ‘Our Story of Care’ the quarterly clinical quality report that includes reference to key clinical indicators, patient experience, incident reports and complaints.

Provided evidence of compliance with the Care Quality Commission revised inspection regime for hospices.

Ratified clinical policies and devised a clinical policies review programme for 2017/2018.

Devised a clinical audit programme for 2017/2018.

Reviewed evaluations returned from patients and families which confirm that teams consistently perform well, and all comments and suggestions are considered by the group.

6

Clinical Quality Markers we monitor The following Clinical Quality Markers form part of our Clinical Quality ‘Our Story of Care’ report and are monitored by the Care Quality Sub-Committee and the NHS South Worcestershire Clinical Commissioning Group Quality Team. 

Complaints: Three complaints were received for this reporting period. All complaints were fully investigated by the Care Quality Lead as Complaints Officer and were within the agreed time frame outlined in our Complaints Policy. Outcomes of the investigations were shared with the complainant and findings and recommendations following the investigation have not been disputed by the complainants. The key findings and learning from complaints have been reviewed by appropriate clinical teams and changes have been made to clinical practice where appropriate.



Compliments: We have received approximately 48 thank you letters, many of which contain detailed stories from patients and families about positive experience of care provided by our clinical teams. In addition, we receive numerous positive comments through social media. During this reporting period the posts, by appearing on users’ news feeds within Facebook, potentially reached 934,640 people and received 118,037comments.

During the reporting period 1st April 2017 – 31st March 2018 there were 261 incidents reported.

All incident reports are collated, recorded and discussed to ensure that action is taken when appropriate and lessons learnt. 

Falls: To enable patients to retain some independence within their life-limiting illnesses falls risk assessments are completed on admission and regularly reviewed. There were 35 falls reported during this reporting year. None of these falls resulted in significant patient harm.



Pressure ulcers: On admission to the In-patient Unit all patients are assessed for pressure damage, any existing pressure ulcers noted and a plan put in place for their care. 39 patients were found to have pressure ulcers prior to admission. The risk of pressure ulcers developing can be reduced by ensuring good hygiene and skin care, monitoring of nutritional intake and regularly repositioning the patient. The Tissue Viability Lead Nurse reviews all pressure ulcers and any ulcers of grade 3 or above are fully investigated to identify root causes. Of the 24 pressure ulcers acquired within the hospice, one grade three pressure ulcer developed and was reported to the CQC and NHS Commissioners. The case was fully investigated and the pressure ulcer was found to be unavoidable.



Medication errors: 6 out of the 23 incidents involved controlled drugs and were reported to the Controlled Drugs Local Intelligence Network (LIN). Each incident was fully investigated. None of the incidents resulted in any adverse clinical outcomes to patients.

7



Infection Control: There was one incident of Methicillin-resistant staphylococcus aureus (MRSA) and two incidents of Clostridium Difficile (C.Diff) during the reporting period. There was one case of Carbapenemase-Producing Enterobacteriaceae (CPE) and no incidents of Vancomycin-resistant enterococci (VRE).

The Infection Control group is proactive in completing annual audits, which are led by three infection control link nurses.



Safeguarding: Care plans for people who lack mental capacity to agree to arrangements for their care or treatment should show evidence of a best interests decision, in accordance with the Mental Capacity Act 2005. Additionally in some cases, due to the level of care and supervision provided, an application for authorisation for Deprivation of Liberty Safeguards must be made to the local authority. During the period of April 2017 – March 2018, 16 applications for Deprivation of Liberty Safeguards were made by St Richard’s Hospice.

A wide range of patients and their families come into contact with services provided by St Richard’s Hospice. Whilst accessing services, and unrelated to care provided by St Richard’s Hospice, our staff identified five vulnerable adult incidents and two vulnerable child incidents that resulted in referral to the Safeguarding Team at Worcestershire County Council for specialist Social Worker review.



Other incidents: During this reporting period there were 90 incidents categorised as ‘other’ of which 4 were patient related. Each incident was followed up in line with St Richard’s Hospice incident reporting policy. The incidents did not result in any adverse outcomes to patients.

Clinical audit The Audit and Evaluation Group aims to support and encourage staff to engage in audit as a way of evaluating care, identifying areas of clinical practice requiring improvement and to take into account published guidelines and evidence. Evaluations of patient and carer satisfaction with our services were completed throughout the year.

Audits for the reporting period include:        

Infection control audits Baseline assessment of pressure ulcer audits Blood transfusion audits Medicines management audits Moving and Handling audit Baseline assessment of diary usage audit Insulin at End of Life audit VTE prophylaxis in patients admitted to In-patient Unit audit Dr Nicola Wilderspin Medical Director 8

Part 3 QUALITY AND PERFORMANCE REVIEW Medical Team St Richard’s Hospice Medical Team provides specialist medical expertise to support the different clinical teams of the hospice, with regular input to the In-patient Unit, Day Hospice and Community Teams. We work in close partnership with the Worcestershire Health and Care Trust’s (HACW) Community Palliative Medicine Consultant, Dr Simon Challand, who provides medical support to the Clinical Nurse Specialist team and with NHS Worcestershire Acute Hospitals NHS Trust’s Consultant, Dr Nicola Heron, who leads the Worcestershire Royal Hospital palliative care team. The hospice Medical Director works in partnership with the other consultants in palliative medicine in Worcestershire to ensure that specialist palliative medicine advice is available to professionals 24/7. In addition, we have a team of interested local GPs who contribute to the provision of on-site medical cover at weekends.

The hospice supports its doctors to maintain their continuing professional development and to meet the requirements of appraisal and revalidation, as required by the General Medical Council. In addition to hospice annual internal performance reviews all doctors also participate in externally provided and quality-assured medical appraisals for revalidation. The hospice is a designated body for revalidation with Responsible Officer services provided by the Medical Director of the HACW through a memorandum of agreement. Two doctors currently have a prescribed connection to St Richard’s Hospice. There have been no complaints or concerns raised about the practice of these doctors.

PATIENT AND CARER FEEDBACK The medical team receive frequent verbal and written appreciation from patients and carers.

However, we are always keen to seek ways in which we can improve and request formal evaluation from bereaved relatives after a loved one has died on the In-patient Unit. In 2017/2018, 118/119 (99%) rated the medical care as excellent/good.

“The doctors were so supportive at this time and were very open and honest in a kind manner of my father’s illness. I felt the calmness of the hospice was beautiful compared to the busyness of the hospital. It was a very difficult time for me and I do believe the doctors and nurses/assistants cared for me as well. Would always recommend St Richard’s Hospice, it is excellent” (May 2017).

“The amazing empathy from all the staff from doctors to cleaners and the amazing way they have always got a smile and comforting word. As nothing was too much trouble even when they must be rushed off their feet as it was full when we were there. Until you have been there you don’t realise how much you do and spend on patients it really amazed me the amount of care and the cost it was first class” (June 2017).

“Staff friendly and helpful. Staff and doctors always available for a chat. Doctors able to spend time with you to explain what is happening. Wonderful facility. Flexible visiting. xx has been a wonderful support to our family” (December 2017).

9

“The doctors explaining clearly what was happening to mum, nursing staff especially xxx, who was with me as mum passed away. The HCAs, especially xxx, who gave me much support and encouragement. Realising what a wonderful place this is” (January 2018).

CLINICAL NURSE SPECIALIST TEAM The St Richard’s Community Nursing Team consists of knowledgeable and experienced staff who are able to utilise their skills to deliver individualised, holistic care to patients, their families and carers. They support and help with the management of symptoms, supporting with making informed choices and identifying and referring on to other services as appropriate.

The method of support is determined by what is most acceptable and preferred by the patient.

This can be through face to face meeting at the patient’s home, GP Surgery or the hospice.

Often there is a combination of face to face and telephone contact.

The Clinical Nurse Specialist Team work alongside other health care professionals, social service departments and voluntary/charity organisations to ensure the patient has the optimum access to the diverse range of services that may be needed to support their care.

Close workings with community services of the GP and District Nurses to offer advice on managing physical symptoms such as pain, nausea or fatigue. The team will spend time with patients, families and carers listening and supporting them with anxieties and worries.

The Secondary Breast Cancer Nurse, within the team, has been part of a partnership group with acute and primary healthcare services in delivering a ‘Living Well’ conference attended by patients, family members and carers. This is planned to be repeated later in the year.

More members of the team are now qualified as non-Medical Prescribers enabling them to prescribe medication as appropriate for their patients as needed. This can allow new medications or changes to current ones being accessed quickly to support the patient and in conjunction with the patient’s GP. St. Richard's Hospice Nurse Specialists Community Referrals 140 120

127

100

80

112

107 97

88

89 86 82

90

96 84

91

97 98

104 101

97 85 86 85

79 82

89

82

60 40 20 0 Apr

May

Jun

Jul Aug Sep 2016/17: 1,068

Oct Nov Dec 2017/18: 1,166

Jan

Feb

Mar

10

South Worcestershire Referrals By Postcode Districts

Total referrals: 1,121 171

180 155

160 140

124

125

123

120

93

100

91 74

80 60 40

37

32

24

24

17

20

28

3

0 WR1 WR2 WR3 WR4 WR5 WR6 WR7 WR8 WR9 WR10 WR11 WR12 WR13 WR14 WR15

St. Richard's Hospice Nurse Specialists: Referral by Post Town 0

100

200

Worcester

500

600

199

Droitwich

155

Evesham

125

Pershore

92

Broadway

Other

400

523

Malvern

Tenbury Wells

300

24

3 45

Total referrals: 1,166

11

3,402

2,678

2,364

3,321

3,839 2,686

3,191

2,427

3,538

2,935

3,542 2,559

3,170

2,688

3,285

2,803

3,243

2,790

3,163

3,294

2,945

2,606

3,000 2,500 2,000 1,500 1,000

3,632

4,500 4,000 3,500

3,846

St. Richard's Nurse Specialist Community Contacts

500 0 Apr

May

Jun

Jul

Aug

Sep

2016/17: 34,702

Oct

Nov

Dec

Jan

Feb

Mar

2017/18: 39,245

PATIENT AND CARER FEEDBACK “We really appreciate the support you gave to us during x’s illness. He valued the honesty and frankness with which you discussed his treatment and pain relief. I think it is fair to say he looked forward to your visits.” (November 2017) “Your visit made such an impact on xx, myself and the family for which I can’t thank you enough…you made a difference to us that day.” (June 2018) “You do a very hard job but you carry it out with humour and optimism which really makes a difference to the patient.” (December 2017)

HOSPICE AT HOME TEAM The Hospice at Home service provides additional support which enables patients to remain in their own home at the end of their lives if this is their preference. The service runs 24 hours a day, seven days a week and can provide urgent overnight or daytime periods of nursing care for patients. The team are experienced healthcare assistants who work closely with GPs and District Nurses to provide additional care to help patients remain at home; providing physical and emotional support to patients, their carers and loved ones.

The team supports patients following discharge from the In-patient Unit or to those patients being cared for at home whilst they are waiting for admission to an In-patient Unit bed. This close working with the In-patient Unit aims to prevent unnecessary admissions to alternative care environments.

Experienced Healthcare Assistants provide nursing care to prevent unnecessary admissions to hospital, particularly if the patient wishes to remain at home during the last few days of life.

The service is available as a short term package of care when patients are most in need – when they are very ill and in the final stages of their illness.

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Hospice at Home: Number of Referrals 50 45 40 35 30 25 20 15 10 5 0

44 38 33

35 36

34 35

37

36

35

34

33

31

29

38

42

41

40

39 33

32

29

28

26

Apr

May

Jun

Jul

Aug Sep 2016/17: 380

Oct Nov 2017/18: 458

Dec

Jan

Feb

Mar

Hospice at Home allocations 350 300 292

280

250 200

150 178

168

282 238 238

224

220

215

287

209

202

205

222

239

208 214

195

168

211 180 174 148

100 50 0

Apr

May

Jun

Jul Aug Sep 2016/17: 2,631

Oct Nov Dec 2017/18: 2,566

Jan

Feb

Mar

Hospice at Home: Number of Individual Patients Supported Monthly 80 70

73

60 60

50 40

64

48 43

46

60

68

65

64 58

59

67

63 56

57

59

56

59 60

50

55 50

41

30

20 10 0 Apr

May

Jun

Jul

Aug Sep 2016/17

Oct Nov 2017/18

Dec

Jan

Feb

Mar

13

Individuals Cared For During Year 400

364

350 300

320

283

275

2014/15

2015/16

250 200

150 100

50 0

2016/17

2017/18

PATIENT AND CARER FEEDBACK “I would like to thank you and the Hospice at Home team for the support provided with such care and professionalism to x and her family during her illness. Without this, she would not have been able to die so peacefully at home as was her wish” (December 2017).

“The family of xx are extremely grateful for the support they received” (May 2018).

IN-PATIENT UNIT The In-patient Unit continues to provide specialist, individualised palliative and end of life care that is totally focused around the needs of the patient and extends to those who are important to them.

We are now caring for and supporting more patients with complex care in terms of physical and emotional needs and as a nursing team have had to draw on more clinical skills in order to provide the care that we do. The introduction of a Clinical Skills Facilitator has enabled the nursing team to develop and update their skills accordingly. We have welcomed and embraced new staff on the In-patient Unit as they have brought a variety of enhanced skills and experience to the established nursing team.

The Gateway Service which was established in January 2017 has enabled more time for the In-patient Unit staff to spend on clinical care. Gateway is the hospice’s, single point of access for all referrals. Previously the In-patient Unit staff took referrals from other Health Care Professionals for admission.

To enable our staff to care for patients in a safe environment, the hospice has introduced clear guidance on security and access for visiting. Visitors are asked that they let the nursing staff know in advance, if planning to visit after 8pm. This is so the staff are aware of who may be intending to visit and for the safety of all staff and patients at night.

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IPU Admissions: Apr. 2016 to March 2018 40

37

35 30

36

35

33

32

30

30

29

27

34 29

28 25

23

25

36

32

23

31

30

25

23

25

23

22

20

15 10 5 0 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Weekday

Weekend

In-patient Unit Monthly Admissions 40 35

34

30 25

20

27

25

29

33 29 30

29

26 27

26 27 27

22

15

18

27

23 22 22

25 21 22

22

18

10 5 0

Apr

May

Jun

Jul

Aug Sep 2016/17: 312

Oct Nov 2017/18: 299

Dec

Jan

Feb

Mar

In-patient Unit Weekend Admissions 10 9 8 7 6 5 4 3 2 1 0

9 8 7

7

6

5 4

4

3

3

3

2

Apr

5

0

May

Jun

Jul

3 1

Aug Sep 2016/17: 30

3 2

Oct Nov 2017/18: 57

2

Dec

1

Jan

3 2

Feb

3 1

Mar

15

Admissions by Postcode Town: South Worcestershire - 292 Worcester

43 27

Malvern Droitwich Evesham

89

18 Pershore

160

Broadway

2 11

40

Tenbury Wells Tewkesbury, Bredon

Admissions by Postcode Town: Other - 65 Kidderminster 11

Redditch 4

Stourport-on-Severn 2

11

Bromsgrove

5

Birmingham

22

1 6

1

21

2

Bewdley

1

Dudley Stourbridge

Hereford Warwick

Italy

Age and Gender by Admission 140

119

120

106 88

100

51

80

51 52

60

40

42 68

20 0 Under 16

356 Admissions

16-18

36

1 1 19-24

55

28

14 25-64 Male

65-74

75-84

85+

Female

16

Time between referral and admission: Apr '17 to Mar '18 Number of Admissions 169 180 160 140 120 100 80 60 40 20 0

140

25

0

1

2

7

7

1

4

3

4

5

6

7

Days since referral

Length of Completed Stays - Admission Count 200

180

150 100

73

50

38

6

20

0

18

< 1 <= 1 Day Week 1 - 2 2 - 3 Weeks Weeks 3 - 4 4-5 Weeks Weeks

15

7 5-6 Weeks

+6 Weeks

357 Completed Admissions

Cancer Diagnosis by Admission: 294 12

Digestive Organs Respiratory & Intrathoracic

7 7 21

Breast

12

Other Specified Sites

14

106

Female Genital Organs Male Genital Organs

16

Urinary Tract Ill Defined, Unspecified

20

Lip, Oral Cavity, & Pharynx Lymphoid / Haematopoietic

Eye, Brain & Other CNS

27 33

37

Palliative Care Diagnoses Independent Multiple Sites

17

Non-cancer Diagnosis by Admission: 62 3

2 1

Other Non Cancer Diagnosis Heart failure

4

Chronic Respiratory Disease

4

24

Dementia End stage renal failure

4

Motor neurone disease Heart / Circulatory Disease 10

Multiple Sclerosis 10

Degenerative Nervous System Diseases

PATIENT AND CARER FEEDBACK “The fantastic care and attention given to my wife by the nursing and medical staff, the dedication was unbelievable, even the volunteers were most helpful, to myself and my family.”

(May 2017) “The care and respect that my father and we as his family, was exemplary. From the moment we arrived it was evident that Dad's needs were an absolute priority and every effort was made to ensure that this traumatic time was made more manageable. For him and us. Staff and environment were wonderful. We feel so fortunate that we were able to spend our last days at such a wonderful facility. We are hugely indebted to you all.” (Sept 2017)

FAMILY SUPPORT SERVICE The Family Support Service continues to provide a wide range of support to patients, their families and carers including counselling, bereavement support, social work, community volunteer support, citizen’s advice and group support. The hospice continues to host Bereavement Support South Worcestershire, a service for those individuals bereaved unexpectedly.

During this twelve-month period the Family Support team:     

Received 1,803 referrals Facilitated 4,113 one to one support sessions Made 4,203 telephone contacts Facilitated 1,936 group attendances Facilitated 201 group sessions

Daily social work support has been maintained throughout the year across all clinical hospice teams. Social Workers continue to attend all daily handovers, clinics and multi-disciplinary meetings in addition to providing the weekday open-door drop in service.

18

The Counselling team continues to work with patients and their families before and following the death of a loved one. This team offers student placements to a number of universities across the midlands region.

Counselling Referrals 40 35 30

34

32

30

25 20 15

29

27 23

21

22

23

27

23 19

18

33

27

24 25

32

25

25

27

22

20 15

10 5 0 Apr

May

Jun

Jul

Aug Sep 2016/17: 300

Oct Nov 2017/18: 303

Dec

Jan

Feb

Mar

In order for the team to meet the increasing number of referrals for support, further family support volunteers have been recruited. They undertook extensive training during this year and are now able to offer 1-1 support as well as to facilitate alongside the staff on the many and varied groups.

The Family Support Team hosted the Carers Tea Party in June 2017 to celebrate National Carers Week. This event was well supported with carers and their loved ones enjoying afternoon tea in the hospice gardens. The Coordinator of the Community Volunteers Team has taken over as lead facilitator with the Carers Café group enabling other team members to facilitate alternative groups. The team organised a Bereavement Friendship Dinner in partnership with the catering department. More than 50 clients enjoyed a three course meal prepared by our catering team and were waited on by members of the Family Support Team.

Clients commented on how it had helped them to re-build their confidence after experiencing the loss of their partner. For many clients this was the first social engagement that they had attended since their loss.

The Family Support Team has now taken on the facilitation of Men’s Space; the group for men with progressive disease. This group runs weekly and has enjoyed visits to Spetchley Gardens & Croome Court as well as guest speakers including a London Marathon runner, a male breast cancer patient & a beer expert. Patients, families, staff and volunteers were invited to the opening of a summer house and green house in the hospice garden, this event was hosted by the Men’s Space group. New referrals were received to this popular group by holding a Men’s Day which was designed to encourage new referrals from acute services as well from hospice clinics and the community teams.

19

The Family Support Team hosted a Walking with Hawks event in August which was very well attended by patients and their families who had opportunity to get close to the hawks as well as enjoying a flying display and educational talks. Our Bereavement Walking Group participated in a day walking the canal towpaths of Droitwich and Hanbury in August.

The team received some funding from Children in Need to run a Children and Familiesâ&#x20AC;&#x2122; Activity weekend and a teenage activity day for bereaved children and parents/carers. Both events evaluated well. In addition, the monthly groups for children prior to the death of a loved one and the group sessions for bereaved children have run throughout the year. All sessions are supported by our skilled staff and volunteers.

Family Support Referrals 250

200

203

189

150

152

143

158 152

132

126

100

158

157

154

182

145 150

159 166

178 155

152 137

131

119

139

96

50 0 Apr

May

Jun

Jul Aug Sep 2016/17: 1,833

Oct Nov Dec 2017/18: 1,800

Jan

Feb

Mar

Family Support Caseload 900 800 700 600 500 400 300 200 100 0

812 704

613

Apr

702 617

May

802 678

714

756

837

807

707

693

798 689

702 703 688

817

790

761

682

727

618

Jun

Jul Aug Sep 2016/17: Ave. 677

Oct Nov Dec 2017/18: Ave. 774

Jan

Feb

Mar

20

Family Support Contact Methods: 2016/17 Vs. 2017/18 6,000 5,000

4,809

4,438

4,000

3,175 2,613

3,000

1,963

1,582

2,000 1,000 0

Telephone

Face to Face 2016/17

Other

2017/18

Family Support Referrals 2017/18 100 90 80 70 60 50 40 30 20 10 0

14

8 5

8 11

12

30

27

18

32

31

26

32

34

Apr

May

Jun

Jul

Bereavement: 432

1

4 19

27

42

36

Aug

Sep

13

25

7

33

32

20

8 15

37

33

40

34

38

Nov

Dec

Jan

Feb

Mar

49

Oct

6

Counselling: 303

25

Pre-death: 97

CAB Referrals 300

240

250

195

200 150 100

219

217

227

184 127

83

76

50 0

2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

21

Citizen's Advice Bureau £'s obtained for clients 2017/18

£217,122

2016/17

£153,333

2015/16

£186,362

2014/15

£109,186

2013/14

£226,024

2012/13

£105,131

2011/12

£103,818

2010/11

£68,930

2009/10

£57,554 0K

50K

100K

150K

200K

250K

The Citizen Advice Bureau Advisers continue to liaise with Government bodies to ensure that they are up to date with benefit news. This enables them to ensure that patients and families access appropriate benefits. Over the twelve years that the CAB Advisers have been working with the hospice, they have raised in excess of one million pounds in benefits and trust fund grants for our patients and their families.

Family Support Groups Sessions 25 22

20 20

19

17

15 15

5

16

15

17

17

15

15 13

12

10

21

20

13 13

14

11

9

8

9

8 5

0 Apr

May

Jun

Jul

Aug

Sep

Group Sessions 2016/17: 143

Oct

Nov

Dec

Jan

Feb

Mar

Group Sessions 2017/18: 201

Family Support Groups Attendees 300 279

250 245

200

203

192

150

175

158 156

151

142

127

123

100

135

169 146

157

138 119

135

134

144

160

98

90

50 38

0 Apr

May

Jun

Jul

Aug

Sep

Attendees 2016/17: 1,678

Oct

Nov

Dec

Jan

Feb

Mar

Attendees 2017/18: 1,936

22

There has been a significant shift in the type of support provided by the community volunteers.

More socially isolated people have been referred, reflecting the isolation that people are experiencing within our community. This also reflects that there are fewer services available within the community for our patients to call upon.

The Coordinator of the Community Volunteers Service continues to work collaboratively with the Education team, Hospice at Home and Day Hospice to develop a specialist team of â&#x20AC;&#x2DC;Healthcare volunteersâ&#x20AC;&#x2122;. This will enable the team to increase the number of carers supported within groups, as the healthcare volunteers will be able to support patients at home allowing their loved one to attend group sessions.

Community Volunteer Referrals 12 10 10

10

10 9

8 8 6

7

7 6

6

6

8

8

7 6

6

6

6

5

4

4

4

4 3

2 2

1

0 Apr

May

Jun

Jul

Aug Sep 2016/17: 81

Oct Nov 2017/18: 68

Dec

Jan

Feb

Mar

Community Volunteer Activity: 2017/18 0

10

20

30

Companionship 51.8%

60

70

23

Shopping 15.8%

18

Housework 7.0%

8

Dog Walking 2.6%

Gardening 0.9%

50

59

Sitting 20.2%

Ironing 1.8%

40

3 2 1

23

Community Volunteers: Average Caseload 45 44 43 42 41 40 39 38 37 36 35

44

44

42

44

42 41 40

40

40

39

39 38

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

The NHS South Worcestershire Clinical Commissioning Group has extended funding for the Bereavement Support South Worcestershire team, until April 2019. This team continues to offer support to those suddenly and traumatically bereaved in South Worcestershire.

Bereavement Support South Worcestershire Referrals 50 45 40 35 30 25 20 15 10 5 0

43 42 35

30

36 37 37

34 29 29

25

26

24

37

33 33

30 30

28

29

31

24

22

18

Apr

May

Jun

Jul

Aug

Sep

Oct

2016/17: 358

Nov

Dec

Jan

Feb

Mar

2017/18: 384

BSSW Referrals: Apr. 2016 to Mar. 2018 50

40

37

35

25

29 25

30

28 24

22

29

36 37 37

34

33

35 30

43

42

45

33

30 29

30

31

26

24

18

20 15

10 5 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2016 2016 2016 2016 2016 2016 2016 2016 2016 2017 2017 2017 2017 2017 2017 2017 2017 2017 2017 2017 2017 2018 2018 2018

Adults

Children

24

Two Snowdrop Celebrations were held at St Martin’s Church in Worcester and in excess of 200 bereaved individuals attended, lighting candles in memory of their loved ones. The Chaplaincy and Family Support Team ran these celebrations in partnership.

The Family Support Team has been closely involved this year with Dying Matters and Hospice Care weeks. Joint working with the hospice Engagement Officer and the Communications Team, has enabled engagement with the public to raise awareness throughout the year of hospice services.

Workshops ran this year, to explore hospice values facilitated by the managers of the Human Resources and Family Support Team. Representatives from all departments were invited to take part in the workshops and questions such as: Where have we come from? Where are we going? And who do we think we are now? were explored. Time was taken to discuss what is important to individual staff members and what is important to the organisation. The outcomes of the workshops will ensure that the values of the staff and organisation are taken forward as we continue to develop new initiatives.

The team works to ensure that we meet the needs of our patients and their families and carers.

In order to do this, we regularly ask for feedback on the services provided. Below are some of the comments received this year.

“The main benefit I found was the opportunity to speak about very painful feelings and also to cry at length, in a safe environment. I felt in some way that I left some of my grief at the hospice each time”. (April 2017) “I lost my only son to suicide and I will never be the same again. I’m so heartbroken and really struggling, but I must say my councillor was a great comfort to me.” (May 2017) “The help I received impacted on my mental wellbeing in a very positive way, which therefore had an impact on my family. The service is priceless and very much needed. Thank you.”

(July 2017) “I could write a book. It’s been tremendous. You do an incredible job – loved it all” (Dec 2017) “I miss him more than ever but with the fantastic coping strategies I have learnt can really manage my feelings. Please don’t go anywhere; your staff and service is far too precious.”

(March 2018).

DAY SERVICES AND OUTPATIENT CLINICS Prior to October 2017 Day Hospice could accommodate up to 20 patients per day, Tuesday to Thursday. The Day Hospice team relocated to a slightly more limited space to enable the expansion of existing Day Hospice to commence and presently accept referrals for up to 12 patients daily. There is a daily Day Hospice multidisciplinary team meeting, to discuss goals set by patients, implement plans of care and a clear discharge plan to ensure that the service responds to referrals in a timely manner. All referrals are processed within one week. The patients who attend Day Hospice have an unstable/deteriorating disease that requires support with symptom control management and significant psychological and emotional support.

25

The 2015 strategic review outlined the need to re-model and expand Day Hospice in order to develop a wellness model. The philosophy will be to empower patients to self-manage their disease and promote quality of life and independence. The Day Hospice team has worked hard to design this new service model and is able to provide a range of service to patients who may require support earlier in their disease trajectory.

The Living Well courses which take place on Fridays were designed to enable patients to have choice, independence and empower them to self-manage their illness.

The programme consists of nine courses:  Adapted Tai Chi (seated)  Adapted Tai Chi (standing)  Relaxation  Coping with illness  Fatigue Management  Managing your Breathlessness  Art and Crafts  Sharing Stories  Spiritual Care The Day Hospice team evaluate the courses and make amendments to course content on the feedback received form patients who have completed individual courses.

Day Hospice Attendance: 2016/17 Vs. 2017/18 3000

2601

2500

2024

1907

2000

1461

1500 1000

577

446

500 0 Places Offered:

Places Taken: 2016/17

Places Declined:

2017/18

Day Hospice Attendance: 2017/18 230

250 200 150

188 42

202

199

53

39

167

59

177 157 38

42

136

28

21 100 146

149

160

50

171 125

139

129

115

144 106

40

47 104 59

111

90 6

31

84

80

Feb 2018

Mar 2018

0 Apr 2017

May 2017

Jun 2017

Jul 2017

Places Taken: 1,461

Aug 2017

Sep 2017

Oct 2017

Nov 2017

Places Declined: 446

Dec 2017

Jan 2018

Places Offered: 1,907

26

Living Well Attendance 180 160 140 120 100 80 60 40 20 0

157 111

99

109

97

93

86

79

111 98

90 75 62

57

62

71

61

44

Apr

May

Jun

Jul

Aug

Sep

2016/17: 531

Oct

Nov

Dec

Jan

Feb

Mar

2017/18: 1,031

Living Well Attendance Summary: 2017/18 250 200

56

12

150 100 50

18 12

36 11

35 11

23 30

35 9

24 15

33

157 99

79

93

111

109

97

25 19

17 29

34

37 17

23 23

57

44

62

62

61

Nov

Dec

Jan

Feb

Mar

0 Apr

May

Jun

Jul

Attended

Aug

Sep

Oct

Did Not Attend

Cancelled by Patient

The consultant led, multidisciplinary, hospice clinics for people with advanced non-malignant diseases (cardiac; renal; respiratory and Parkinsonâ&#x20AC;&#x2122;s disease) continue to evaluate well with patients and families. We are grateful to NHS South Worcestershire Clinical Commissioning Group for continuing to fund the clinics and to specialist clinicians from the NHS Trusts for collaborative partnership working.

Outpatient Specialist Palliative Clinic Attendance: 2017/18 - 260 40 35 30

13

25 8

20 15 10

5 0

6

7 7 5 5

Apr

6

6

3

7

8

May

Jun

Heart Failure Clinic

8

7

6

7

8

6

7

3 4

7

5

6

5

5

5

5

7

7

8

8

6

7

7

6

8

7

4 4

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

6

Respiratory Clinic

Renal Palliative Clinic

Parkinson's Clinic

27

Outpatient Specialist Palliative Clinic Attendance: 2016/17 Vs. 2017/18

40 35 35

30

25 20 15

25

23

26 25

24 23 24 24 22

22

17 16 17

20 21

15

10

22

25 24

27

25 20

13

5 0

Apr

May

Jun

Jul

Aug

Sep

2016/17: 275

Oct

Nov

Dec

Jan

Feb

Mar

2017/18: 260

DAY SERVICES EVALUATION FEEDBACK “A safe, welcoming environment with professional and caring staff. The volunteers are cheerful and kind.” (January 2018) “The best thing was being able to discuss with others about illness. Having people you can call on if you need help or guidance.” (January 2018) “Just a short note to say thank you for masterminding the various courses which I have taken part in. The staff are all wonderful, very caring and knowledgeable. Your volunteers have similar qualities. Thank you for the opportunities that you have all given me”. (April 2018)

OCCUPATIONAL THERAPY In order to provide a timely service to all areas, one designated Occupational Therapist covers the In-patient Unit providing advice and support for people returning home following admission. The occupational therapists provide a home assessment service and, if appropriate, provide equipment to support and maintain patient independence and safety as well as providing psychological support to prepare patients and their families with the adjustment in their roles.

The other Occupational Therapist provides cover to both the Day Hospice and palliative outpatient clinics. This involves home assessments, provision of equipment to maintain a person’s independence at home, advice regarding home adaptations, assessing access to enable patients to attend Day Hospice safely via volunteer transport and close liaison with the community occupational therapy teams. They work closely with the nursing staff, Physiotherapist and medical team to identify patients who would benefit from occupational therapy and plan treatment.

The Occupational Therapists have provided support, with a greater focus on rehabilitation in palliative care and have been actively involved in facilitating therapeutic groups and activities for the Living Well programme within Day Hospice.

28

Home visits take up a large proportion of the Occupational Therapists’ time, partly due to the large geographical area covered by St Richard’s, and some patients require more than one visit to review treatment or fit equipment. It is sometimes necessary to carry out joint assessments with representatives when patients require more bespoke equipment to meet their needs.

PHYSIOTHERAPY Physiotherapy referrals continue to come predominantly from the In-patient Unit and Day Hospice. Physiotherapists also support a number of the Living Well courses.

Exercise classes take place every day in Day Hospice. These classes are now facilitated not only by the Physiotherapist, but also by volunteer therapists and other members of the team who have received training. Assessment prior to exercise is always undertaken by a Physiotherapist.

Yoga treatments - 2017/18: 211

Tai Chi treatments - 2017/18: 128 30

40

27

25

36

35

23 21

30

20

25

15

13

12

10 5

25

Jan

Feb

13

15 10

4 2

25

20

12

8 5

29

27

26 23

7

5

1

0

0 Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Apr

Mar

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Mar

The physiotherapy teams have continued their links with the West Midlands regional group, Association of Chartered Physiotherapists in Oncology and Palliative Care (ACPOC) group, attending joint meetings at other hospices. Rehabilitative palliative care, goal setting and respiratory care have been the main focus and have informed practice of the physiotherapists at St Richard’s.

An additional physiotherapist has now been trained in acupuncture and this is becoming integrated in holistic patient management across the hospice.

Physiotherapy Referrals 45 40 35 30 25 20 15 10 5 0

42

42

42

37 28 23

26

28

27

21

34

32

30

22

41

32

35

32 32 27

25

21

20 15

Apr

May

Jun

Jul

Aug Sep 2016/17: 305

Oct Nov 2017/18: 409

Dec

Jan

Feb

Mar

29

2016/17: 3,934

Physiotherapy Treatments: 2016/17 Vs. 2017/18 0

250

500

750

1,000

1,250 1,500

378 351

Exercise Therapy

Functional Assessment Breathing Control Clearance of secretions of respiratory tract Acupunture for Analgesia Provision of medical equipment Pain relief Advice about exercise Bowen Technique Exercise class Teaching

2,000 2,250

552 561

Mobility Assessment

Moving and handling assessment

1,750

1,909 1876

Physiotherapy

Referral to physiotherapy service

2017/18: 3,828

206 256 160 192 132 145 129 130 83 100 50 83 64 79 99 26 34 17 8 134 4 4

EDUCATION AND RESOURCE CENTRE St Richardâ&#x20AC;&#x2122;s Hospice is passionate about supporting palliative and end of life education and training for staff, volunteers and the health and social workforce in Worcestershire.

Education Department developments The department has seen some significant changes over the last 12 months. The new head of education and learning came into post in September 2017. The team now consists of a mix of part time personnel who have a broad range of skills to enable the hospice to continue to deliver high quality education and learning opportunities both for staff internally and to benefit the wider health economy by sharing the specialist expertise of the hospice with generalist practitioners.

For example, there is now a clinical skills facilitator who works one day a week with In-patient Unit staff as well as practicing within an Intensive Care Unit. As a result she is able to maintain the currency of her expertise whilst supporting staff in the hospice In-patient Unit to develop their skills to meet the complex needs of patients who need specialist palliative care.

The department has been very fortunate to have been bought a clinical skills simulation mannequin. This can be used in a variety of ways to give staff the opportunity to enhance their clinical skills and maintain their competence. A staff member from each department has been trained in its use and the education team will increasingly be using it as part of the range of training it provides.

30

The department has also introduced an apprenticeship role to support the coordination of educational experiences within the hospice.

Mandatory training: The team have completed a review of mandatory training to ensure that all our contractual obligations are met and also to ensure the mandatory training has a positive tangible impact on the delivery of quality patient care.

Continuing professional development: Continuing professional development is supported for all staff across the hospice. Individual staff and volunteers have had 1652 attendances at training sessions provided by the education department this year. Staff have been supported to attend 270 external study days courses and conferences in the last 12 months. This has ensured that not only are our staff able to maintain their expertise and unique skill set but are also able to convey learning and innovation from outside of the organisation, fuelling the rich vein of creativity that keeps our services forward thinking and responsive to changing patient and family needs.

External Training: The education team has delivered training to 323 members of staff from outside of the hospice in the last 12 months. This helps to fulfil the mission of the hospice to share expertise and learning which will help patients and their families outside of our direct care to access services that can provide a good patient experience at the end of life.

Gold Standards Framework: The hospice is a regional centre for the delivery of the Gold Standards Framework training for end of life care. This training facilitates care homes and care homes with nursing to develop a culture which supports excellence in end of life care for their residents. We are currently supporting 9 homes through the training.

Support for students and trainees: The hospice values the opportunity to support and train the future workforce and to this end we have supported students in the last 12 months.

These include medical students from the University of Birmingham, student nurses, physiotherapists, occupational therapists, and paramedics from the University of Worcester.

For the first time this year the hospice welcomed physician associate trainees to the In-patient Unit on 5 day placements.

The hospice has provided support for trainee general practitioners and other junior doctors and continues to support Palliative Medicine specialty training.

A highlight of the year was when the department facilitated 65 students from the local college to talk to experienced health and social care staff from within the hospice. The question and answer sessions enabled the young students to gain a good understanding of the care the hospice provides and the day to day challenges that health care professionals face in the delivery of care.

31

“Thank you for an interesting experience! Changed my impression of hospices for the better” (medical student March 2018) “Very emotive moving lecture - inspiring.” (Nursing home member of staff January 2018) “Really interesting and well delivered with plenty of opportunity to be interactive.” (External delegate February 2018)

CHAPLAINCY TEAM AND SPIRITUAL CARE The Chaplaincy Team provide support to in-patients, day patients, families, staff and volunteers. In addition, the team reach a wider population through the many funeral services and community events they conduct. The team has also conducted relationship blessings, marriages, baptisms and the distribution of silver leaves to families for the Tree of Life. The silver leaves are engraved with words in memory of loved ones who have died.

The Chaplaincy Team were involved with 5 Lights of Love services in November and December, the inaugural Carols in the Car Park, and 2 Snowdrop Celebrations in April and May, contributing to an estimated number of 3500 people reached by community events during the year. Events provide opportunities to renew acquaintances and to provide additional assistance as required and are appreciated by many people.

Staff support also forms part of our work and this was provided both formally and informally throughout the year. The team provides spirituality and chaplaincy information to staff as part of their induction programmes and to medical students as part of their hospice clinical placement. Two trainee clergy have undertaken placements with the team in all areas of chaplaincy.

A Spirituality Course is offered as part of the Friday Living Well programme, entitled “Finding inner peace”. It is designed to be suitable for people of all faiths and those without any faith.

PATIENT AND CARER FEEDBACK “Just a little note of thanks for allowing us to share with the other families in the Snowdrop Celebration. It was nice to again be part of the St Richard’s family and to feel the continued love and support. The service was beautiful and gave us much comfort” (Relative, April 2017).

“Just wanted to say a huge thank you for allowing me to spend the day with you on Friday and for making me feel so welcome. The work you and your volunteers do is admirable” (Student nurse, December 2017).

“Thank you for officiating at the service in such a perfect way. It has been such a difficult time for us, but our own brief encounters with you have done much to ease the pain” (Relative, January 2018).

32

VOLUNTEER SERVICES Patient Services Volunteer Annual Report 1 April 2017 – 31 March 2018 Category Admin

Total Hours

Total Value

Accounts Administrator Education Administrator Family Support Administrator Fundraising Administrator General Day Hospice HR Administrator Volunteer Services Administrator Admin

441 5 69 1,163 11 75 687 2,450

£3,551.02 £36.23 £553.08 £9,362.97 £84.53 £604.62 £5,531.44 £19,723.89

Chaplain Chaplaincy

1,069 1,069

£16,029.35 £16,029.35

Community Sitter Community Social Community Care

42 1,936 1,977

£302.00 £15,582.86 £15,884.86

Reception Main Building Facilities

5,811 5,811

£43,349.30 £43,349.30

Counsellor Family Support Volunteer Listening into Action Reception Snowdrop Telephone Bereavement Support Family Support

538 470 3 4 24 1,039

£7,536.90 £6,573.00 £40.60 £30.00 £340.20 £14,520.70

Bath Nurse Clinic Support Day Hospice Volunteer Hair Dresser Saturday Social Group General Day Hospice

370 878 5,914 221 139 7,522

£2,744.11 £12,292.70 £44,067.77 £1,634.96 £1,941.80 £62,681.34

IPU Helper In-Patient Unit

1,275 1,275

£9,505.84 £9,505.84

Complementary Therapist Creative Diversional Physiotherapist Therapies

497 75 11 583

£5,493.19 £856.02 £199.39 £6,548.60

413 807 471 1,691

£3,070.67 £6,022.81 £3,506.02 £12,599.50

146 146 23,563 Number of Sessions of Volunteering: Number of Volunteers: Number of Opportunities:

£2,044.70 £2,044.70 £202,888.08 6,225 312 29

Role

Chaplaincy

Community Care

Facilities

Family Support

General Day Hospice

In-Patient Unit

Therapies

Transport Driver-Minibus Driver-Own Car Escort-Minibus Transport Yoga Therapist General Helper

Yoga Therapist

33

COMMUNITY ENGAGEMENT Between April 2017 – March 2018, the Community Engagement Officer engaged with over 4,500 people through face-to-face activity. Six priority areas have been identified to focus the direction of Community Engagement – these are Islamic and Eastern European Communities, geographical area of Evesham, lower income communities, 55+ and rural communities.

Role activity included:  

    

Before I Die board on Worcester and Evesham High Street, large supermarkets and Malvern Theatre to promote Dying Matters Awareness Week and Hospice Care Week Engagement with local Eastern European community at Polish Heritage Day, Polish film screenings in Evesham, Catholic Churches and local mother and toddler group for Polish families Two open afternoons at St Richard’s with over 200 attendees Continuing to build relationship with local mosques, including new ladies’ mosque group Exploring a volunteering role to support community engagement and widen our reach Representing hospice at health and wellbeing, community and older people’s events Delivering awareness talks to appropriate audiences

The Community Engagement Officer has a work plan for 2018 to ensure direct engagement with priority areas.

FUNDING OUR CARE Fundraising The fundraising environment continues to be challenging with income from both the general public and statutory sources reduced. Attracting voluntary income to sustain hospice contributions to the health and wellbeing of the individuals in the Worcestershire community is becoming increasingly vital. A further consideration is the plethora of new and emerging charities in the community all seeking donor support. During the next financial year St Richard’s has the challenge of raising more than £8.8million to fund the hospice services and plan for the future. A capital appeal in support of our development work is also presently under way and we seek an additional £5.3m on top of our revenue requirement to extend the facilities and service provision at the hospice. We also aim to develop new services and ways of working to continue to offer the very best specialist palliative care to patients and to support their loved ones. The hospice cannot do this without on-going support from the community and the involvement of many individuals, groups, clubs, schools, churches and local businesses. Trust and grant organisations remain committed to helping us, as do those that choose to leave St Richard’s a gift in their Will and this makes a huge difference to our work.

We are indebted to everyone who supports us.

Lottery At the end of the financial year Worcestershire Hospices Lottery has been able to distribute just over £106,000, as opposed to £92,000 in 2017, to each of the three hospices that it raises funds for: St Richard’s Hospice, Primrose Hospice & Acorns Children’s Hospice. The original 34

lottery was set up by St Richard’s Hospice & Acorns Children’s Hospice and covered South Worcestershire. Since Primrose Hospice joined us in 2015, we now also draw members from the north of the county, Bromsgrove, Redditch & Wyre Forest. This expansion of area has also seen our profits grow significantly.

The lottery has been running for 19 years and has raised almost £3 million for the hospices, which helps with their day to day running costs.

Commercial A challenging year on the high street also has an impact on our charity shops with a decrease in footfall. Despite this decrease our shops have still traded well with many up on last year.

Turnover rose to £2.6m from £2.4m last year. The net profit was similar to last year at £588,347.

Gift aid to continues to be an important growth area for the business generating extra income of £128,000. The output of goods within our shops has risen from 608,000 items to 655,000 items. The Trading Company activities are only possible with the dedicated support of our shop managers and ancillary staff supported by our volunteers.

The quality of the donations we get contributes greatly to the success and the look of our stores we have handled over 445 tonnes in this financial year, this does not include furniture.

This could not be achieved without the support of our 655 volunteers.

We endeavour to make our shops as professional as possible, to emulate the high standards of the In-patient Unit and related nursing care. I hope in the following year the investment we have made in support staff will come to fruition and increase our net profit contribution.

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Our Core Values

GOVERNANCE STRUCTURE – NOVEMBER 2017 Council of Governors Governors Senior Management Team Heads of Departments SRH Staff External

Hospice Services Committee Professor R Lewis (Chairman) Mrs J Cowpe Dr S Challand Mrs T Grint Dr N Heron Dr M Keeble Dr J Quallington Mrs A Sullivan Dr R Woof Mrs J Patel – Chief Executive Dr N Wilderspin – Medical Director Listening into Action Representative ***** Mrs R Ayris – Secretary

Care Quality Sub-Committee Professor T Thompson OBE (Chairman) Mrs J Cowpe Mrs V Gibson Miss C Gijselhart Mrs T Grint Mrs F Howarth Mrs S P-Helm Ms S Wardell Mrs D Westwood Prof T Thompson OBE Dr N Wilderspin ***** Mrs R Ayris – Secretary

Mr J Bawden (Chairman) Mrs J Cowpe – Vice Chairman Professor R Lewis – Vice Chairman Mr R Shaw – Treasurer Mr G Bartholomew Mrs H Edwards Mr P Flagg Mr A Glossop Mr S Hyslop Mrs A Palmer Dr J Quallington Cllr A Roberts Miss B Sheridan Professor T Thompson OBE Senior Management Team Mrs T Cavell – Fundraising Director Mr D Corns – Commercial Director Mrs J Patel – Chief Executive Dr N Wilderspin – Medical Director ***** Mrs A Grout - Secretary

Strategy Group Professor R Lewis (Chairman) Mr G Bartholomew Mrs J Cowpe Professor T Thompson OBE Mrs J Patel – Chief Executive Dr N Wilderspin – Medical Director

St Richard’s Hospice Trading Company Mr A Glossop (Chairman) Mrs C Adams Mr D Corns Mr S Hyslop Mrs J Patel Mr J Woodcock ***** Mrs A Grout - Secretary

Finance & General Purposes Committee Mr R Shaw (Chairman) Mr G Bartholomew Mr J Bawden Mrs H Edwards Mr P Flagg Mr A Glossop Mrs A Palmer Cllr A Roberts Miss B Sheridan Mrs T Cavell – Fundraising Director Mr D Corns – Commercial Director Mrs J Patel – Chief Executive Mr D Haigh ***** Mrs A Grout - Secretary

Remuneration Committee

Investment Committee

Mr J Bawden (Chairman) Mr A Glossop Mrs J Patel Mrs A Palmer Mr R Shaw Mrs A Walford

Mr J Bawden (Chairman) Mrs H Edwards Mrs J Patel Mr R Shaw Investment Manager ***** Mr D Haigh - Secretary

Information Governance Steering Committee Mrs J Patel (Chairman) Mr R Mistry Mrs T Cavell Mr D Corns Mrs L Clive Mr D Haigh Mrs D Scott Mrs D Westwood Mrs A Walford Dr N Wilderspin **** Mrs A Grout - Secretary

Major Incident Team Mrs L Clive (Chairman) Mrs T Cavell Mr D Corns Mrs H Griffee Mrs F Howarth Mrs J Patel Mrs A Walford Dr N Wilderspin

Health & Safety Committee Mrs L Clive (Chairman) Miss S Arshad Mrs R Lewis Mrs T Cavell Mr D Corns Mrs V Gibson Miss C Gijselhart Mrs J Welch Mrs T Grint Mr K Ratcliffe Mrs D Westwood 37 Mrs A Walford

WHAT WORCESTERSHIRE CLINICAL COMMISSIONING GROUPS SAY ABOUT ST RICHARD’S HOSPICE

Over the last year the CCGs have been impressed with the quality of the patient care and support that St Richard’s Hospice provides for its service users and the organisation is clearly developing strongly, with its “Build 2020” project. St Richard’s continues to work closely with the local community through their community engagement initiatives and the CCGs feel that the Board, management team, staff and volunteers at St Richard’s should be extremely proud to be a part of an organisation that offers exceptional patient care and support to the people of Worcestershire.

The CCGs continue to be impressed with the efficiency with which St Richard’s run their services and exceed patient needs and expectations as evidenced within the patient and carer feedback sections under Part 3 of the Patient Services Report and Quality Account. The CCGs look forward to continued close working with St Richard’s and the completion of the ‘Build 2020’ project.

Dale Elliott Contracts Support Manager NHS Redditch and Bromsgrove CCG | NHS South Worcestershire CCG | NHS Wyre Forest CCG

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WHAT HEALTHWATCH WORCESTERSHIRE SAYS ABOUT ST RICHARDâ&#x20AC;&#x2122;S HOSPICE

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Addendum Following feedback from Healthwatch Worcestershire, as outlined above, 16 applications for Deprivation of Liberty Safeguards were made by St Richardâ&#x20AC;&#x2122;s Hospice.

Out of these, 14 patients died before approval, 2 patients were discharged from St Richardâ&#x20AC;&#x2122;s Hospice. The local authority were kept informed.

With respect to incidents, by comparison there were 90 other incidents in 2017/2018 compared to 89 in 2016/2017.

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