Patient Services Report and Quality Account 2018-2019
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 OUR PURPOSE, VISION AND VALUES .............................................................................. 2 Part 1 ..................................................................................................................................... 3 Chief Executive’s Statement .............................................................................................. 3 Priorities for Improvement 2019-2020 ................................................................................ 3 Future planning .................................................................................................................. 4 Priorities for improvement 2017-2018 ................................................................................ 4 Summary of achievements ................................................................................................. 4 Part 2 ..................................................................................................................................... 5 Statement of Assurance from the Board ............................................................................ 5 Review of services ............................................................................................................. 5 Participation in clinical audits ............................................................................................. 6 Research ............................................................................................................................ 6 Quality Improvement and Innovation goals agreed with our Commissioners ..................... 6 What others say about us .................................................................................................. 6 Data Quality ....................................................................................................................... 7 Our Commitment to Clinical Quality, Patient Safety and Dignity ........................................ 7 Part 3 ................................................................................................................................... 10 Quality and Performance Review ..................................................................................... 10 Medical Team................................................................................................................... 10 Patient and carer feedback .............................................................................................. 11 Clinical Nurse Specialist Team......................................................................................... 11 Patient and carer feedback .............................................................................................. 14 Hospice at Home Team ................................................................................................... 14 Patient and carer feedback .............................................................................................. 15 In-patient Unit ................................................................................................................... 15 Family Support Service .................................................................................................... 19 Day Services and Outpatient Clinics ................................................................................ 29 Day Services evaluation feedback ................................................................................... 32 Occupational Therapy ...................................................................................................... 32 Physiotherapy .................................................................................................................. 33 Complementary Therapy .................................................................................................. 35 Education and Resource Centre ...................................................................................... 36 Chaplaincy Team and Spiritual Care................................................................................ 37 Volunteer Services ........................................................................................................... 38 Community Engagement .................................................................................................. 39 Funding our Care ............................................................................................................. 39 Governance structure – November 2018 ......................................................................... 41 What Worcestershire Clinical Commissioning Groups say about St Richard’s Hospice .. 42
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OUR PURPOSE, VISION AND VALUES Our purpose To care for adults with a serious progressive illness, improving their quality of life from diagnosis, during treatment and to their last days. We also support their loved ones. Our vision That people affected by a serious progressive illness and their loved ones have access to a range of free, excellent care and support to enable them to live life to the full. Who do we care for? We care for people with a serious progressive illness who have complex needs which cannot be met by other services. These include cancer and neurological, respiratory, cardiac and renal conditions. All our services are available to people registered with a South Worcestershire GP. Our Inpatient Unit cares for people across Worcestershire. Our shared values These values define our relationships with all those we care and support; our colleagues and the wider community. Caring: • Caring is at the heart of everything we do. • We are inclusive and treat everyone as an individual who we respect and value. • We take time to listen and respond to the needs of each person. Compassionate: • We work with empathy, sensitivity and understanding. • We are considerate, kind and fair. • We support and empower individual choice. Committed • We are dedicated, reliable and hard working. • We continuously strive to deliver high-quality services. • We support each other and work together for the benefit of our patients and loved ones. Professional • We aspire to be the best in everything we do. • We are innovative and develop our skills through continuous learning and evaluation. • We take responsibility for our actions and are accountable. St Richard's Hospice is an integral part of the local healthcare economy in Worcestershire. It is an independent, registered charity, supported by local communities. St Richard's Hospice has a unique function in providing specialist supportive Palliative Care free of charge to all those in need.
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Part 1 CHIEF EXECUTIVE’S STATEMENT PRIORITIES FOR IMPROVEMENT 2019-2020 2018/2019 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 the autumn of 2019. The transformation of our Day Hospice model of care and the new, expanded multi-purpose space and Living Well centre 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: An 86-year-old gentleman, who has pulmonary fibrosis, learned techniques to help bring episodes of breathlessness under control and how to use his lung capacity efficiently within the breathlessness sessions which are part of the hospice’s Living Well programme. “Most helpful were tips when we were short of breath and panicking – we were taught how to be in control,” he explained. “Once a patient can get over the fact they are attending a hospice and appreciate these sessions are to enable them to live life as fully as possible despite their condition, then one can fully participate in their efforts to keep you healthy and mobile by strengthening various muscles and pacing oneself”, Patient March 2019 Patient wife explained the sessions had resulted in her husband feeling “more in control of his disability”. “We cannot thank the staff of the hospice enough. St Richard’s is not just there for those at the very end of life, but also to help those with life-limiting conditions. “The result of our experience is that he is using less bottled oxygen and feels more in control of his disability. “From the breathlessness sessions, they are more in control and better equipped to continue living a better life experience. We were quite sad to finish”, Patient wife March 2019”. 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 and we look forward to contributing to the End of life care workstream as part of the Strategic Transformation plan for Worcestershire and Herefordshire. 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. 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. 3
FUTURE PLANNING It must be noted that implementation of these priorities is dependent upon the ability to raise the necessary funds. Improvement Priority 1: Develop a Clinical Strategy outlining a clear clinical vision which enables St Richard’s clinical and Family Support teams to support the delivery of exceptional person-centred specialist end of life care, through continuous service improvement confirmed by positive feedback from patients and loved ones. The completion of the In-Patient Unit review will be undertaken as part of this workstream. Improvement Priority 2: Aspire to an Outstanding rating by CQC following the next unannounced visit. Improvement Priority 3: Continue to support the development of our workforce (Staff and volunteers) informed by the development of a workforce strategy which identifies workforce priorities, clinical skills and competencies to continually enhance the clinical care and services provided to patients and their loved ones. Improvement Priority 4: Develop a partnership and collaboration strategy to strengthen and develop opportunistic partnership working with established and new stakeholders aligned to the NHS, Hospices, Commercial and Fundraising portfolios, our communities and the people we serve. Improvement Priority 5: Develop a digital strategy informed by horizon scanning and content of the STP Digital Strategy for Worcestershire and Herefordshire and identify potential, Artificial Intelligence and Digital innovations to augment patient care, access to services, clinical productivity and different ways of working.
PRIORITIES FOR IMPROVEMENT 2017-2018 (Taken from St Richard’s Hospice Patient Services Report and Quality Account 1st April 2017 – 31st March 2018) SUMMARY OF ACHIEVEMENTS Improvement Priority 1: Complete building project for re-configured Reception, Day Hospice and upper floor extension. Partially completed 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. Completed 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. Continuous review Improvement Priority 4: Complete the service review of the In-patient Unit in order to identify areas to transform clinical care and patient experience. Partially completed 4
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 2018/2019, accounted for 19.45% 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 • Bereavement Support South Worcestershire • 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 2018/2019, 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 2018/2019 that were recruited during that period to participate in research approved by a research ethics committee was 4. St Richard’s Hospice, in collaboration with University College London, recruited patients 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, with a total of 47 patients recruited. Site monitoring and close-out visits have been completed by the study sponsor. 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 2018/2019. The last on-site unannounced inspection took place on 14th and 15th March 2016, the overall rating for St Richard’s is ‘Good’.
On 29th May 2019 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. From the review commissioners gained good assurance of the high quality of patient care being delivered by the hospice.
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DATA QUALITY St Richard’s Hospice did not submit records during 2018/19 to the Secondary Users Service for inclusion in the Hospital Episodes Statistics which are included in the latest published data. Information Governance Toolkit For 2018/2019 St Richard’s Hospice met all mandatory standards within the NHS Data Security and Protection toolkit. The submission is a requirement under the terms of the NHS Contract. June Patel Chief Executive OUR COMMITMENT TO CLINICAL QUALITY, PATIENT SAFETY AND DIGNITY Achievements in 2018/2019 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 Clinical Quality & Patient Safety sub-committee (formally care quality sub-committee) which reports directly to 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. Clinical Quality & Patient Safety 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 Clinical Quality & Patient Safety Sub-Committee, comprising of Clinical Heads of Department, Medical Director, two Governors, the Care Director and Care Quality 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 Independent Healthcare. Hospices now are regulated under this inspection regime. Ratified clinical policies and devised a clinical policies review programme for 2018/2019. Devised a clinical audit programme for 2018/2019. Reviewed evaluations returned from patients and families which confirm that teams consistently perform well, and comments and suggestions are considered by the group.
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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 Clinical Quality & Patient Safety Sub-Committee and the NHS South Worcestershire Clinical Commissioning Group Quality Assurance Team. •
Complaints: 5 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 87 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 322,442 people and received 35,510 engagements including likes, comments and shares.
During the reporting period 1st April 2018 – 31st March 2019 there were 224 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 49 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. 46 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 Link Lead Nurse reviews all pressure ulcers and any ulcers of grade 3 or above are fully investigated to identify root causes. Of the 12 pressure ulcers acquired within the hospice, four grade three pressure ulcers developed and were reported to the CQC and NHS Commissioners. The cases were fully investigated to determine any learning or further actions.
•
Medication errors: 5 out of the 18 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.
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•
Infection Control: There was two incident of Methicillin-resistant staphylococcus aureus (MRSA) and two incidents of Clostridium Difficile (C.Diff) during the reporting period. There were no case of Carbapenemase-Producing Enterobacteriaceae (CPE) and three incidents of Vancomycin-resistant enterococci (VRE). Patients were transferred into the organisation with these infections already identified. One Clostridium Difficile (C.Diff) case was reported to the CCG Infection Prevention Control team and a root cause analysis was completed. This case was attributed as a post case due to admission time and time to sample, although recognised the patient had multiple admissions to other NHS provider hospitals. The Infection Control group is proactive in completing annual audits, which are led by four infection control link nurses across clinical services.
•
Safeguarding: Care plans for people who lack mental capacity to agree to arrangements for their care or treatment should show evidence of a best interest’s 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 2018 – March 2019, 18 applications for Deprivation of Liberty Safeguards were made by St Richard’s Hospice. 14 patients died before approval, 3 were discharged form St Richard’s Hospice. 1 patient was assessed to have capacity and therefore the application was cancelled. 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 three vulnerable child incidents that resulted in ongoing support internally from the Social work team. None required referral to the Local Authority for further follow up.
•
Other incidents: During this reporting period there were 58 incidents categorised as ‘other’ of which 35 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. In comparison 90 ‘Other’ incidents were reported 2017/18 of which 4 were patient related.
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 Blood transfusion audits Medicines management audits Moving and Handling Day Services audit 9
• • • • • • • • • •
Acupuncture audit Medical prescribing audit Corticosteroid prescribing audit Antimicrobial prescribing audit Waterlow Day Services audit Emergency medicines audit Re-audit of venous thromboembolism prophylaxis (VTE) in patients admitted to St Richard’s Hospice in-patient unit (IPU) A quality improvement project focussing on the prescription and use of Oxygen in an inpatient hospice environment. Protected Characteristics baseline audit Mouthcare matters baseline audit Dr Nicola Wilderspin Medical Director
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 Consultants, in particular the Palliative Medicine Consultants who lead 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 health 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 service level 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.
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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 2018/2019, 126/126 (100%) rated the medical care as excellent. “The genuine care and kindness that was shown to us both (including visitors) by all the staff and volunteers. The time doctors spend with us at a difficult time. I would like to mention community nurse xxx who helped us through my husband's chemotherapy and radiotherapy treatment - a very scary time for us. Nothing was too much trouble for her”. (April 2018) “Knowing mum was being cared for. The tireless emotional support and care from everyone from cleaners to doctors. The whole family felt loved and cared for. I don't know what we would have done without St Richard's. x “ (May 2018) “The medical care and doctors, in particular, were amazing - kind, patient and gave us precious "time" to ask questions and understand the impact of bad news. The outside space is lovely and peaceful and loved the bird feeders. Mum felt "safe" at the hospice in her final days”. (June 2018) “Excellent doctors who took time to explain what was happening. Nurses always sympathetic and helpful to both mum and relatives”. (November 2018) “Doctors very patient and calming when talking to my mum and myself. The nurses only came in when needed and let us spend the time with my mum. Didn't ask us to leave when mum passed away but they were there when needed”. (February 2019)
CLINICAL NURSE SPECIALIST TEAM The St Richard’s Community Nursing Team consists of Clinical Nurse Specialists and Senior Staff Nurses, all of whom have a wealth of experience, knowledge and skills to support patients, families and carers with a variety of malignant and non-malignant diseases in the community. This is holistic care, supporting their physical, psychological and often social needs, enabling them to make informed choices and decisions as to their care needs and future planning. The way in which this support is received is determined by the patient and those important to them and offers referral to other support services within the hospice as well as the ongoing support of the community nursing team. This support is usually face-to-face at the patient’s home or by telephone contact. Patients can be seen in an outpatient setting at the hospice if this is a preference. The Community Nursing team work in close partnership with other health and social care providers, other voluntary and charitable organisations and close working with colleagues in acute hospital care. This allows for optimum access to a variety of support and range of services ensuring choice and promoting independence as appropriate.
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Close working alongside community colleagues such as General Practitioners and District Nurses offers advice and support with managing physical symptoms such as pain, fatigue or nausea/vomiting. The nurses will spend time with patients, families and carers listening to and supporting with anxieties and worries. There are a four Non-Medical Prescribers within the team enabling them to prescribe when appropriate medication for their patients. The patient’s GP is always informed as to any changes or introduction of new medication. By being able to prescribe medication for the patient any new or changed medication can often be accessed quicker. Within the Community Nursing team is a Secondary Breast Cancer Nurse Specialist, this is an innovative role delivered by St Richard’s Hospice with the nurse working in the Worcestershire Royal Hospital. This service provided to the patients is dependent on their individual requirements and allows for them to be reviewed in hospital outpatients, oncology clinics, at home or in the hospice. This nurse works closely with Oncology Consultants, medical teams and other services within the hospice. Women’s Space, a group for women with progressive disease is offered in conjunction with the hospice Family Support team.
St. Richard's Hospice Nurse Specialists Community Referrals 140 120
127
100 80
99
97 97 86 83
114
112
107
97
87
98
91
101 88 86
74
60
104
98 86 82
91 82
69
40 20
0 Apr
May
Jun
Jul
Aug
Sep
2017/18: 1,167
Oct
Nov
Dec
Jan
Feb
Mar
2018/19: 1,089
12
South Worcestershire Referrals by Postcode Districts 160
Total Referrals: 1,037
149
142
133
140 119
120
100
89
93
86
80
62
60 40
42
40
21
27
18
20
15 1
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
300
400
500
Worcester
476
Droitwich
149
Malvern
148
Evesham
142
Pershore
94
Broadway
27
Tenbury Wells
1
Other
52 Total Referrals: 1,089
St. Richard's Nurse Specialists: Contacts 4,500
1,500
3,213
3,402
3,107
3,321
3,249
3,839 2,921
3,191
3,232
3,538
3,757
3,230
3,170
3,503
3,285
3,499
3,243
3,186
3,163
2,945
2,000
2,882
2,500
2,606
3,000
3,453
3,500
3,542
4,000
1,000 500 0 Apr
May
Jun
Jul
Aug
Sep
2017/18: 39,245
Oct
Nov
Dec
Jan
Feb
Mar
2018/19: 39,232
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PATIENT AND CARER FEEDBACK “The support received from (name of CNS) was just wonderful and that she was a support of contact in their worst times. They talked at further length at how much they appreciated the compassion, support and professionalism they received” (Feedback given to a Social Worker at a ‘Day after death’ meeting, 03/2019) “(Name of CNS), How can I ever thank you for all your care to ….she trusted you very much. Your support helped me to look after her and for that I thank you.” (Friend and carer of patient, letter sent, 02/2019) “(Name of patient) received exceptional care from St Richard’s Hospice and particularly her Hospice Nurse (name of CNS).” (Order of Service and acknowledgements for patient’s funeral, 03/2019)
HOSPICE AT HOME TEAM Hospice at Home: Number of Referrals 50 45 40 35 30 25 20 15 10 5 0
44 38
37
36
33 27
29
28
38
36
34
42
40 41 41
39 38 34
27 24
25
24 21
19
Apr
May
Jun
Jul
Aug
Sep
2017/18: 458
Oct
Nov
Dec
Jan
Feb
Mar
2018/19: 337
The Hospice at Home service is an integral part of the Community Nursing team providing direct physical care and psychological support to patients, their families and carers. The service is provided by experienced Healthcare Assistants and runs across 24hours and seven days a week. The Hospice at Home team work closely with others providing care for patients in the community, including General Practitioners, District Nurses, charitable and private care providers to offer skilled care to an optimum for patient need. This is often when there is a crisis or need for an urgent response to provide care. Much of the work provided by this service allows and supports patients to be in their preferred place of care at home or prevents them from being admitted to hospital or enables them to be discharged home from hospital or St Richard’s Hospice In-patient Unit whilst other care providers are sought. Often the team will provide supportive care when a patient is at the end stage of their illness enabling to stay at home and offering the support, guidance and reassurance to their loved ones. 14
Hospice at Home: Number of Individual Patients Supported Monthly 80 70 60
64
60
50 48
40
51
60
68
65
64
67
63
54
54 43
49
45
53
56 57
55 49 50
48
44
60
30
20 10 0 Apr
May
Jun
Jul
Aug
Sep
2017/18
Oct
Nov
Dec
Jan
Feb
Mar
2018/19
Hospice at Home: Individuals Cared for During Year 400
364
350
300
320 283
275
2014/15
2015/16
278
250
200 150 100
50 0 2016/17
2017/18
2018/19
PATIENT AND CARER FEEDBACK “I would like to say a big thank you to all the lovely nurses in Hospice at Home. I can’t tell you how much I appreciated all the care and kindness given to (name of patient) during his last few weeks”, (relative of patient, card of thanks, 02/2019) “The help came at a time when I was really feeling the strain of caring for him at home and I know he was always glad to see ‘your girls’ and grateful for their help”, (wife of patient, card of thanks, 02/2019)
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
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The Nursing Team consists of skilled, knowledgeable and experienced staff who are able to deliver patient centred, holistic clinical and nursing care to the patients and their families. The dependency and acuity of patients and families increase year on year and the team continue to support patients with complex symptoms. The nursing staff work closely with the Education Team to ensure that we are continually developing skills and maintaining competency in delivering specialist palliative and end of life care. “The level of care was outstanding, really could not have been any better at all - you are all amazing people in an amazing place” March 2019 “Your kindness, compassion and respect and humour when needed was whole-heartedly felt and appreciated” April 2019 “To all the staff at SRH-would like to thank you all for the dignity, care and respect shown and given to mum-we knew mum was happy spending the end of her life with you all” April 2019 Weekday Weekend
In-patient Unit Admissions: April 2017 to March 2019 40
36 33
35
32
37 34 31
29
30 25
36
30
25
30
29
32
32 27
26
25
23
22
28
29
28
26
23
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 2017 2017 2017 2017 2017 2017 2017 2017 2017 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 2019 2019
In-patient Unit Monthly Admissions 40 35
37
30
32
29 29 30
25
33
26
26
27 26
27 28
23
20 15
32 29
18
29
28 27 26
22
22
22
18
10 5 0 Apr
May
Jun
Jul
Aug
Sep
2017/18: 299
Oct
Nov
Dec
Jan
Feb
Mar
2018/19: 347
16
In-patient Unit Weekend Admissions 10 9 8 7 6 5 4 3 2 1 0
9
9
8 7
6
7
6 5
4
4
4
4
3
4 3
3
3
2 Apr
May
Jun
Jul
Aug
3
2
Sep
Oct
2017/18: 57
3
3
2
Nov
Dec
1
Jan
Feb
Mar
2018/19: 48
South Worcestershire Admissions by Postcode Districts 300 Admissions / 276 Patients 42
45 37
40
34
35
33
32
30
27
30
25 18
20
18
15
10 5
6
4
8
5
5 1
0 WR1
WR2
WR3
WR4
WR5
WR6
WR7
WR8
WR9 WR10 WR11 WR12 WR13 WR14 WR15
Admissions by Postcode Town 347 Admissions / 318 Patients 180
166
160 140 120 100 80
Tenbury Wells
12
4
3
3
4
4
1
Alcester
1
Broadway
16
5
Hereford
18
20
Tewkesbury, Bredon
30
Bewdley
38
Bromsgrove
42
40
Redditch
60
South Worcestershire: 300
Stourport-on-Severn
Kidderminster
Pershore
Evesham
Malvern
Droitwich
Worcester
0
North Worcestershire: 38
Other: 9
17
Admissions by Age Ranges and Gender
Male
Female
66
70 60
50
50
41 40
40
32
30
23
17
20 10
18 18
14
12
6
1
2
7
0 1911 1920
1921 1930
1931 1940
1941 1950
1951 1960
1961 1970
1971 1980
1981 1990
347 Admissions: 173 M ale , 174 Fe male
Time between referral and admission: April 2018 to March 2019 Numbe r of Admissions 180 160 140 120 100 80 60 40 20 0
155 123
33 16 0
1
2
3
6
8
4
5
3 6
7
Days since re ferral
Length of Completed Stays - Admission Count 140 120 100 80 60 40 20 0
135
36
51
65 21 14
<= 1 Day
<= 1 1-2 Week Weeks 2 - 3 3-4 Weeks Weeks
17 1
4-5 Weeks
5-6 Weeks
+6 Weeks
Completed Admissions: 340, Ongoing Admissions: 14
18
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 deliver Bereavement Support South Worcestershire, a service for those individuals bereaved unexpectedly. Counselling and Social Work Students have successfully obtained placements with the team this year. During this twelve-month period the Family Support team: • Received 1,716 referrals • Facilitated 2,527 one to one support sessions • Made 4,736 telephone contacts • Facilitated 2,032 group attendances • Facilitated 207 group sessions 19
The team continues to assess each client referred and offers individual support based on the need of the patient and family.
Counselling Referrals 35 30
30
32
30
25
27
20 15
24
23
18
26
30
25
24
23
20 21
20 19
17
33
31
30
25
19 16
15
10 5 0 Apr
May
Jun
Jul
Aug
Sep
2017/18: 300
Oct
Nov
Dec
Jan
Feb
Mar
2018/19: 278
Family Support Caseload 900 800
846
839
700 704 600
812 790 802
702
743 756 767
807 781
837
809
799 798 795
840
761
703
790
751
817 800
500 400 300 200 100 0 Apr
May
Jun
Jul Aug Sep 2017/18: Ave. 774
Oct Nov Dec 2018/19: Ave. 796
Jan
Feb
Mar
20
Family Support Contact Methods: 2017/18 Vs. 2018/19 6,000
5,000
4,809
4,736
4,000
3,175
3,000
2,527 1,963
2,000
1,782
1,000 0 Telephone
Face to Face
2017/18
Other
2018/19
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, Social Workers provide a weekday open-door drop in service for patients, families and professionals. The graph below indicates that this is an increasingly well used service.
21
Social Work Drop-in Summary 2018/19 19
20 18 17
18
18
15
16
14 13
14 11
12
11
10 9
10
9 8
8 7
8 5
6
5
4 3
4
4 3
2
4
4
3
3
2
2
2
1
2
8
7
2
1
0 Apr
May
Jun
Jul Aug Sep Oct Nov Dec Jan Patients: 83 Families: 77 Professionals: 92
Feb
Mar
Family Support Groups Sessions 30 25 20
15
19
21 20 19
21
22 22 21
20
17
17 17 15
10
24
13
17
14
15 16
17 13 12
11
5 5 0 Apr
May
Jun
Jul
Aug
Sep
Group Sessions 2017/18: 201
Oct
Nov
Dec
Jan
Feb
Mar
Group Sessions 2018/19: 207
Men’s Space, the group for men with progressive disease launched a calendar with a tea party in the hospice garden. The group hosted the party and the calendar was on sale from September. Innovative projects such as this have been woven throughout the year, including a ‘Walk with Hawks’ day at Croome Park was organised for clients who have participated within a group throughout the year. They were invited to share a picnic and to watch a bird of prey display.
22
Family Support Groups Attendees 300 279
250 200 192
150
158
171
175
167
142
100
217
209
194 203
189
169
166
151 151 125
125
135
160
176
134 142
50 38
0 Apr
May
Jun
Jul
Aug
Sep
Attendees 2017/18: 1,936
Oct
Nov
Dec
Jan
Feb
Mar
Attendees 2018/19: 2,032
The team continues to support individuals and families in their homes and within schools if they do not wish to be seen at the hospice. Support for other professionals working directly with children, is a key part of the work the team undertakes. The hospice received funding again this year from Children in Need. This grant will enable the children and family’s team to focus on supporting teenagers. This is in addition to the monthly groups which are provided for children prior to the death of a loved one, and the group sessions for bereaved children which have run throughout the year. All sessions are supported by skilled staff and volunteers. The Social Work team has worked with the Education team to introduce Safeguarding Advocates across the organisation. This means that all teams including non-clinical areas now have an advocate who they can discuss safeguarding concerns with and escalate, as required, to Safeguarding leads within the organisation. During this reporting period, the team provided training to a local primary school enabling staff to explore how they could support children pre and post bereavement. Telephone support has been provided to a number of teachers and parents when they have telephoned in for general advice. The team had a stand at the University of Worcester Personal, Social, Health and Economic (PSHE) fayre 2019 (re pre-& post bereavement support for children) encouraging trainee teachers to address the difficult subjects of death dying and bereavement with pupils as part of their Personal, Social, Health and Economic (PSHE) education. This is defined by the school’s inspectorate Ofsted as a planned programme to help children and young people develop fully as individuals and as members of families and social and economic communities. The social work team were pleased to be invited to participate in this important area of teacher training education. Following on from a joint project on hospice care and bereavement with a local grammar school, the head of the Family Support team gave an oral presentation to the Hay Literary Festival during 2018. Subsequently another group of General Certificate of Secondary Education (GCSE) drama students visited the hospice in December 2018. The students developed a theatre production called ‘Growing Around Grief’ based on the information given during their visit. 23
The team continues to support other hospice events including the running of Men’s Space and supporting with the Snowdrop Celebration Remembrance services. They have also been involved with hospice working groups exploring homelessness and learning disability. In-patient Unit interventions represent a significant amount of the social work team’s work, with the need to support complex family situations, patients’ and family members’ psychosocial and emotional needs prior to and following a death. Family meetings continue to take place both formally and informally, and a proactive role is maintained in patient discharge planning including referring for external services when required. The Counselling team continues to work with patients and their families before and following the death of a loved one. Referrals continue to be complex and varied. The team continues to offer student placements to a number of universities across the midland’s region. Four students had placements from various universities / places of learning this year. This enables the continuation of our service as students learn and develop and once qualified may become valued and well-known volunteers for the hospice. Whilst it is recognised that mental health services in the community are limited, it is also recognised that hospice family support are not designed or able to support some presenting issues. Some clients are either referred back to the GP or signposted to appropriate services. The NHS South Worcestershire Clinical Commissioning Group confirmed this year that funding for the Bereavement Support South Worcestershire team will be ongoing. This team continues to offer support to those individuals who are suddenly and traumatically bereaved in South Worcestershire. Citizen's Advice Bureau: £'s Obtained for Clients 0K 2009/10
2010/11
50K
100K
150K
200K
£68,930 £103,818
2012/13
£105,131
2013/14 2015/16
2016/17 2017/18 2018/19
300K
£57,554
2011/12
2014/15
250K
£226,024 £109,186 £186,362 £153,333 £217,122
£238,872
24
Citizen's Advice Bureau: Referrals 300
240
250
222 197
200
226
219 188
150
176
128
100
78
50 0 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
This year has seen a change within the Citizen Advice Bureau team. New staff have joined and work with the wider team to continue to provide support in a flexible and skilled way. 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. Since 2009 the Citizen’s Advice Bureau Advisers have raised in £1,466,332 in benefits and trust fund grants for our patients and their families. Community Volunteer Referrals 14 12
13
10
11 10
10
8
10
9
9
9
8 6
7
7 6
4
6 5
6
7 6
6
6
5 4
2
3 2
1
0 Apr
May
Jun
Jul
Aug
Sep
2017/18: 68
Oct
Nov
Dec
Jan
Feb
Mar
2018/19: 98
25
Community Volunteers: Average Caseload 50 45 40 35 30 25 20 15 10 5 0
43
41 36
Apr
36
May
38
36
Jun
39 38 39
Jul
41
40 35
Aug
35
Sep
2017/18: 39
41 36
Oct
38 33
Nov
34
Dec
37
36 31
Jan
35 29
Feb
30
Mar
2018/19: 34
Community Volunteer Activity: 2018/19 0
50
100
Companionship 59.6%
250
300
93
Housework 9.9%
44
Ironing 3.6%
Dog Walking 1.8%
200
264
Shopping 21.0%
Gardening 2.5%
150
16 11 8
The Community Volunteers Service has undergone a review. This service was originally based around the compassionate community’s model and it now sits within the Family Support Service. Volunteers from this service and the hospice bereavement service will be working more closely together providing the best possible emotional and practical support to our patients and their families. Community volunteers continue to provide support: befriending, sitting, shopping and ironing are some examples of provided. Feedback suggests that having a volunteer visit to provide company and a welcome break from being alone whilst facing a life limiting condition is appreciated and has a positive impact on the individual.
26
Bereavement Support South Worcestershire: Individual Support Referrals 50 45 40 35 30 25 20 15 10 5 0
43 36 29 30
34 29
May
37
36
37 30
24
Apr
34
Jun
23
34
26
Aug
32 33
23
21
Jul
31
30
31 22
18
Sep
Oct
2018/19: 339
Nov
Dec
Jan
Feb
Mar
2017/18: 384
The Child and Family Support Practitioner has continued to work alongside the Social Work team in order to provide group support for children and young people. Children supported by Bereavement Support South Worcestershire have joined the Dragonfly Bereavement Groups run by the hospice. Even though their bereavements have been so different, the families have gained a great deal from meeting with each other and sharing their stories. Bereavement Support South Worcestershire Referrals: April 2017 to March 2019 50
43
45
36 37 37
40 35 30
34
36 33
30 29
30
31
34
26
31 32
30
29 24 23
25 20
34
21
23
22
18
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 2017 2017 2017 2017 2017 2017 2017 2017 2017 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2019 2019 2019
Adults
Children
All bereaved clients requesting support are invited to attend a short course of bereavement sessions where they are supported and have the opportunity to meet with staff, volunteers and others in the same situation. The team assesses who might benefit from attending other groups available i.e. STEPs social group, the walking or cookery group or a more therapeutic group. Those individuals are invited accordingly. Individuals requiring 1-1 support are offered emotional support with a Family Support Volunteer or with a member of staff. 27
In order to manage an increase in referrals across services, the team is encouraging people to access group support, which offers peer support as well as support from the hospice team. This way of working has reduced the waiting lists and enabled staff and volunteers to offer 11 sessions with those individuals who have complex need. The team have developed a process to enable them to liaise with the local Foodbank enabling our patients and family to access this invaluable service. 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. The team worked with the Communications Officers to facilitate live Facebook sessions. Discussions on support for bereaved children and young people, carers and group support enabled the public to link in with the Family Support team and ask questions or share experiences with a wide audience. These sessions are available to watch on the website and are a useful resource for patients, families and professionals. 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. “It brought clarity to my thoughts prior to the counselling to think and function was such an effort. The counselling got me functioning. At the time it felt no one could help – but you did. Thank you.” (May 2018) “We have actually grown stronger through this painful experience and I believe that your skill, patience and wisdom has helped us get to where we are now.” (October 2018) “I don’t know where I would be, or even if I would be here now, thank you so much. I know my life won’t ever be the same but you’ve helped me turn the corner.” (October 2018) “If I don't have the volunteer I would struggle to do my day to day shopping.” (November 2018) “My little boy is really enjoying his time with you and has asked when he’s going to see you next - he’s really positive about the time you’ve spent with him and has taken in a lot more than I thought he might have ..... we have many conversations about heaven at the moment - some have been hysterical as you can imagine and I’ve struggled to keep a straight face who knew that God that was very good at back massages?” (March 2019) “This group has given me the opportunity to meet with other bereaved people who are in a similar position to myself. This brings me enormous comfort during this very difficult time.” (Steps bereavement group. March 2019) “Men’s Space has given me a unique opportunity to spend time with people in a similar situation to myself, one that is often difficult to discuss with friends and family. This is a very safe environment where I can discuss any concerns that I have and it is a huge comfort to know that I’m not alone.” (Men’s Space Group, March 2019)
28
DAY SERVICES AND OUTPATIENT CLINICS The Day Services Team relocated back to the newly refurbished and spacious new build in Nov 2018. The newly refurbished space has meant that there is more space to carry out exercise groups, such as yoga and Tai Chi. The new space has modern and updated equipment to support the Living Well model of care and can accommodate up to 16 patients. 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. The 2015 strategic review outlined the need to re-model and expand Day Services in order to develop a ‘Living Well’ model and a stepped model of care. The philosophy is to empower patients to self-manage their disease and promote quality of life and independence. The Day Services team has worked hard to design this new service model and is now able to provide a range of services to patients who may require support earlier in their disease trajectory. Patients can be signposted to the different levels within the stepped model of care depending on how much therapeutic intervention they require at that time. The Living Well courses which currently 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 twelve courses: • • • • • • • • • • • • •
Adapted Tai Chi (seated) Adapted Tai Chi (standing) Relaxation Coping with illness Fatigue Management Managing your Breathlessness Art and Crafts Sharing Stories Finding Inner Peace Christian Pilgrim Tree of Life Horticultural Therapy Men’s Space
Living Well referrals continue to increase and the team are working hard to promote the service to GP’s and other health care professionals externally. The Day Services team evaluate the Living Well courses and make amendments to course content from the feedback received form patients who have completed individual courses.
29
Social groups are now running in Day Services and current patients and carers can attend or people with a serious progressive Illness who are not known to the hospice can attend. The following social groups are now running: • • • •
Knit and Knatter Making Life Easy Through Technology Love Books Understanding Pain and its Management Day Hospice Attendance: 2017/18 Vs. 2018/19 2,500 1,907
2,000
1,461
1,352
1,500
1,025 1,000 446
500
327
0 Places Offered:
Places Taken:
2017/18
Places Declined:
2018/19
Day Hospice Attendance: 2018/19 180 160 140 120 100 80 60 40 20 0
166 41
126
127
112 26
25
26
121 35
108 89
91 29
69
19 125
86
Apr 2018
May 2018
116
122
35
38
105
19
25
9 100
Jun 2018
102
Jul 2018
Places Taken: 1,025
86
Aug 2018
70
79
Sep 2018
Oct 2018
60
72
81
84
80
Nov 2018
Dec 2018
Jan 2019
Feb 2019
Mar 2019
Places Declined: 327
Places Offered: 1,352
30
Living Well Attendance 180 160 140 120 100 80 60 40 20 0
157 138 114
99 79 75
81
93
111 101
109 100
97
99
71
62
62
57 44
Apr
May
Jun
Jul
Aug
Sep
2017/18: 1,031
Oct
Nov
98 62
61 63
37
Dec
Jan
Feb
Mar
2018/19: 1,039
The consultant led, multidisciplinary, hospice clinics for people with advanced non-malignant diseases (cardiac; renal; respiratory and Parkinson’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.
31
Outpatient Specialist Palliative Clinic Attendance: 2018/19 - 263 30 25
5
7
7
7
20 9
15
6
7
6
4
6
May
Jun
Jul
0 Apr
Heart Failure Clinic
4
4
3
3
Aug
Sep
Respiratory Clinic
6
7
5
7
6
5
7
7
5
6
7
8
9 5
9
8
7 7
10
7
8
6
5 7
Oct
3
6
4
5
7
6
5
Nov
Dec
Jan
Feb
Mar
Renal Palliative Clinic
Parkinson's Clinic
Outpatient Specialist Palliative Clinic Attendance 40
35 35
30 25
28
26
27
26
20
15
23 22 22 17
10
17
17
24
20
15
12
25
28 27
25
22
20
20
13
12
5
0 Apr
May
Jun
Jul
Aug
Sep
2017/18: 260
Oct
Nov
Dec
Jan
Feb
Mar
2018/19: 263
DAY SERVICES EVALUATION FEEDBACK “Everyone - staff and volunteers are friendly and helpful and the food is fantastic”. (Patient March 2019). “I recognise symptoms earlier and deal with them better”. (Patient from the Fatigue Management course Dec 2018). “Companionship with people with similar problems”. (Patient January 2019).
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. 32
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. 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 Referrals continue to be mainly from the In-patient Unit, the Day Hospice and the palliative clinics. Physiotherapists also support the Living well Programme leading courses in Adapted Tai chi and breathlessness management. The number of patients seen continues to rise with more than one hundred additional new referrals in 2018/2019 compared to 2017/2018 Patients referred require a comprehensive physiotherapy assessment due to the complexity of their needs in the context of advanced disease with multiple comorbidities. A treatment plan is then implemented to address the patient’s goals and needs. A variety of treatments are offered for improving function and mobility, pain relief including acupuncture, transcutaneous electrical nerve stimulation (TENS), respiratory management and exercise. Exercise classes take place every day in Day Hospice. These classes are 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. As physiotherapy services expand, we have trained exercise volunteers who work with patients in the Day Hospice or in their own homes carrying out exercise programmes under the guidance of the physiotherapists. “X keeps me going. No way would I do the exercises like that on my own and I always feel better after - she makes it fun” (patient- community exercise volunteer experience 24 June 2019) “The physiotherapist on the breathlessness management course has made me feel some control again. I know what to do and can put it into practise when I am walking” (Patient breathlessness management course 17 June 2019)
33
Physiotherapy Referrals 50 40
44 37
30 20
43 42
42
39 35
28
34
31 32
45
42 43
42
45
41 37
36
32
27
35 27
25
10 0
Apr
May
Jun
Jul
Aug
Sep
2017/18: 409
Oct
Nov
Dec
Jan
Feb
Mar
31
30
2018/19: 475
Tai Chi Treatments 45
40
40 35 25 20
29
27
30 19
14
15 10
1314
13
15 12
10
11
Dec
Jan
8
5
2
5
23
21
18
12
4
1
0 Apr
May
Jun
Jul
Aug
Sep
2017/18: 128
Oct
Nov
Feb
Mar
2018/19: 244
Yoga Treatments 60
54
50 37
40 30
37
36
29 23
20
13
27
26
25
29
25
15
8
10
3
7 5
7
Dec
Jan
3
4
Feb
Mar
0 Apr
May
Jun
Jul
Aug
Sep
2017/18: 211
Oct
Nov
2018/19: 202
34
2017/18: 3,828
Physiotherapy Treatments: 2017/18 Vs. 2018/19 0
250
500
750
1,000
1,250
729 351 391 256 253
Referral to physiotherapy service
192 176
Moving and handling assessment
145 159
Functional Assessment
130 155
Breathing Control
79 89
Provision of medical equipment
100 60
Clearance of secretions of respiratory tract
17 51
83 49
Acupunture for Analgesia
Teaching Exercise class
2,250 2,117
Exercise Therapy
Pain relief
2,000
561
Mobility Assessment
Bowen Technique
1,750
1,876
Physiotherapy
Advice about exercise
1,500
2018/19: 4,299
8 41 26 17 11 4 1
COMPLEMENTARY THERAPY There are two qualified Complementary Therapists who manage the service. The service also relies on Complimentary Therapy Volunteers. The following Complementary Therapy treatments are offered: • Indian Head Massage • Relaxation • Aromatherapy • Massage • HEARTS • M Technique Treatments are offered to patients and carers in the In-patient Unit, Day Services and outpatient appointments.
Complementary therapy word cloud: prominent words from patient feedback responses following treatments 2019. 35
EDUCATION AND RESOURCE CENTRE Education at St Richard’s continues to thrive with the ethos of not only supporting our staff to deliver exceptional care but also to support the wider health economy to develop in relation to palliative and end of life care provision. Education Department Developments The department has seen significant changes with the Head of Education leaving to take up post as the Care Director and a new Head of Education being welcomed to the organisation. The team has recruited new members including a new education learning facilitator and education administrator who as well as supporting the smooth running of the department will have the remit of supporting staff to access e-learning. Project ECHO® The hospice has been fortunate to get financial support from NHS Health Education West Midlands to roll out Project ECHO® This is an exciting venture that uses digital technology to enable us to share our expertise in end of life and palliative care with health care professionals. In partnership with the NHS Health and Care Trust a network has been created and developed for Band 5 community nurses. The nurses were invited to the hospice to determine their own curriculum for the ECHO sessions in October 2018. Since then a total of 22 nurses from 12 neighbourhood teams have now accessed the sessions which comprise of a teaching session and case-based learning. The project has been a fantastic example of collaboration across teams in the hospice (facilities, administration, education, clinical, Information Technology) and with the wider NHS. The project has been made possible by our renewed Information Technology infrastructure. Mandatory Training As the new schedule of mandatory training enters its second year staff have adapted well to utilising e-learning and have praised the face to face medicines management training that has been developed by our learning facilitators. Continuing Professional Development Individual staff and volunteers have attended training sessions provided by the education department throughout the year. 691 external study days, courses and conferences have been accessed, which are invaluable to ensure our staff remain up to date and are able to use the latest evidence in their practice. External Training As well as project ECHO® mentioned above the education team have delivered training to 194 members of staff from outside the hospice. This helps fulfil the mission of the hospice to share expertise and learning which will help patients and families outside our direct care experience excellent care at the end of life. 36
Support for Students and trainees The hospice prides itself on the excellent support and education it provides for the future workforce. 61 students have been supported from a wide variety of disciplines including Medicine, Nursing, paramedics, social work, physiotherapy and administration.
CHAPLAINCY TEAM AND SPIRITUAL CARE The Chaplaincy team provide support to in-patients, day and community patients, families, friends, staff and volunteers. From April 2018 – March 2019 the team: • Officiated at 44 funerals. This number is a reduction on previous years due to a Community Chaplain vacancy during August, September and October • Conducted 2 Snowdrop Celebration (Memorial) services in conjunction with the Family Support Department • Conducted 5 Lights of Love services and 1 Carol Service in conjunction with the Fundraising Department • Conducted 1 pre-wedding blessing for a patient’s daughter • Arranged a civil wedding with the Worcester Registrars for a patient, followed by prayers and a blessing • Distributed 38 silver leaves to be hung on the Tree of Life in memory of a loved one • Led a service for the Worcester Royal Infirmary Nurses’ League • Reached an estimated 4935 people through funerals, Lights of Love and other community services and events • Made 2947 patient contacts and 1841 contacts with family and friends • Provided informal staff support on 105 occasions, largely of a personal nature In addition, the team arranged for patients and their visitors to take part in the RSPB Big Birdwatch to promote spirituality linked to the outdoors and to enjoy our beautiful garden. Chaplaincy staff also supported the Before I Die engagement board and the Lantern Walk and helped to promote a variety of staff engagement activities for Interfaith Week. Teaching and sharing expertise formed an important element of our work and included taking part in the staff and volunteer induction programmes and the student nurse and medical student teaching programmes. Two local clergy in training joined us for 6 days each to give them an insight into a different area of ministry. “Thank you for the beautiful service you conducted for us. What a wonderful celebration, he would have been so pleased. It was like the very best school assembly ever to remember an outstanding teacher!” A relative August 2018 “Thank you so much, our family really can’t thank yourself and the rest of the hospice staff enough. The funeral was beautiful and was more than Dad would have wanted.” A relative December 2018 “Thank you to you and all involved in last evening’s service. So pleased the rain held off and it wasn’t too cold. The inter-faith messages were very interesting and it was all very meaningful.” Carols in the Car Park attender December 2018
37
VOLUNTEER SERVICES Patient Services Volunteer Annual Report 1 April 2018 – 31 March 2019 Category Admin
Role Education Administrator Family Support Administrator Finance Administrator Fundraising Administrator HR Administrator Volunteer Services Administrator
Total Hours Total Value 2 £16.10 6 £46.29 619 £4,981.12 1,460 £11,750.03 188 £1,513.10 548 £4,413.58 2,822 £22,720.22
Chaplaincy Chaplain Community Care Community Shopping Community Sitter Community Social
1,373 1,373
£20,588.25 £20,588.25
2 580 611 1,193
£16.10 £4,540.66 £4,919.42 £9,476.18
1,192 4 2 186 8 287 5,947 7,628
£9,107.18 £32.20 £17.62 £1,422.02 £66.17 £2,214.59 £45,762.81 £58,622.59
7 1,183 961 15 2,167
£98.00 £16,567.60 £13,459.60 £214.90 £30,340.10
21 872 5,703 39 68 6,702
£162.85 £12,214.30 £43,915.37 £297.49 £949.20 £57,539.21
2,632 2,632
£20,271.90 £20,271.90
687 687
£7,592.72 £7,592.72
385 706 364 1,455
£2,951.26 £5,423.02 £2,783.17 £11,157.45
4 4 26,664
£56.00 £56.00 238,365 7151 360 32
Facilities Hospitality Assistant Facilities Administrator Flower Arranging Gardener Kitchen Maintenance Reception Main Building Family Support Carers Group Hosts Counsellor Family Support Volunteer Telephone Bereavement Support General Day Hospice Bath Nurse Clinic Support Day Hospice Volunteer Hair Dresser Saturday Social Group In-Patient Unit IPU Helper Therapies Complementary Therapist Transport Driver-Minibus Driver-Own Car Escort-Minibus Yoga Therapist General Helper
Number of Sessions of Volunteering: Number of Volunteers: Number of Opportunities:
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COMMUNITY ENGAGEMENT Between April 2018 – March 2019, the Community Engagement Officer engaged with over 8,000 people through face to face activity. Awareness raising has continued with talks to appropriate groups and information displays in GPs, community hospitals and health events. Other engagement projects include: Engaging with the Asian Community: we regularly engage with Friends of Worcester Mosque to build a relationship with the largest mosque in Worcester. The Chairman delivered an information session to staff and volunteers for Interfaith Week and we delivered a craft session for the mosque youth group. Homelessness: A hospice and homelessness working group has been created with local partners to explore end of life care for people experiencing homelessness. The working group has undertaken a survey to explore training needs for hospice and homeless workers. Learning disabilities: St Richard’s Hospice made three pledges in Speakeasy NOW’s Growing Older and End of Life White Paper. As a result, we have created hospice information in easy read format and started an internal learning disability working group to explore access and involvement for people with a learning disability. The Community Engagement Officer has a work plan for 2019 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 £9.3million 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 and dependant on their continued generosity and financial donations.
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Lottery At the end of the financial year Worcestershire Hospices Lottery has been able to distribute over £107,000, as opposed to £106,000 in 2018, to each of the three hospices that it raises funds for: St Richard’s Hospice, Primrose Hospice & Acorns Children’s Hospice. The original lottery was launched in 1999 by St Richard’s Hospice & Acorns Children’s Hospice and covered South Worcestershire. However in 2015, Primrose Hospice of Bromsgrove joined as a partner, which enabled us to 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 20 years, with over 10,000 members playing each week and has raised over £3 million for the hospices, which helps with their day to day running costs. Commercial I am pleased to report that the investment into our shops mentioned in my report last year has been successful. With an increase in 19.5% on our net profit contribution to the Hospice’s patient care services. I am pleased to report that our strategy of increasing the size of our shops was completed with the final move of Tewkesbury and Droitwich during this last year. Albeit the high street has had a challenging year and we as a charity retailer are not protected from the same issues other traders face. However, we have seen an increase in turnover from £2.6 - £2.9 million. Gift Aid stills plays a large contribution to our growth and the financial contribution Gift Aid made this year was £207,000. I cannot stress enough how important it is to capture as many gift aid sales as possible, each one percent increase on gift aid sales represents £22,000 per year. As we continue to grow we are more and more heavily reliant on the contribution and loyalty of our volunteers and staff. Huge amount of work is done behind the scenes to be able to present our shops in a professional way. Quality donations are essential to see a growth in our transaction value. We sold 669,617 items this year with 368,312 individual transactions within our shops, this was an increase of 5.37% on last year. Our average sales value was £7.61 which was 3.72% up on the previous year. These increases can only be sustained with the great donations we receive from our donors. Thank you for your support and allowing us to achieve this success.
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GOVERNANCE STRUCTURE – NOVEMBER 2018 St Richard’s Hospice Governance Structure
Council of Governors Chair: Chair of Governors
Clinical Quality & Patient Safety Sub Committee Chair: Governor
Infection Control Group Chair: Care Quality Lead
Chair: Chief Executive
Finance & General Purpose Sub Committee Chair: Treasurer
Worcestershire Hospices Lottery Chair: Commercial Director
Audit and Evaluation Group Chair: Care Quality Lead
Strategy Implementation Group
Listening into Action Chair: Care Quality Lead
Trading Company Chair: Governor
Remuneration Committee Chair: Governor
Information Governance Committee Chair: SIRO CEO
Service/Development Sub Committee Chair: Governor
Investment Committee Chair: Governor
Health and Safety Committee Chair: Facilities Manager
Research Development Group Chair: Medical Director
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WHAT WORCESTERSHIRE CLINICAL COMMISSIONING GROUPS SAY ABOUT ST RICHARD’S HOSPICE
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