Annual Review 2019
What we do St Richard’s cares for adults with a serious progressive illness, improving their quality of life from diagnosis, during treatment and to their last days.
We work with other health-care partners to prevent crisis intervention and hospital admissions where possible.
We also support their loved ones.
We care for people affected by 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.
Last year we gave co-ordinated care and support to over 3,400 patients, loved ones and the bereaved.
We offer in-patient care for patients from the Wyre Forest, Kidderminster, Redditch and Bromsgrove areas.
We aim to improve patients’ quality of life, helping them to live as fully as they can to the end of their lives, however long that may be.
Everything we do is made possible thanks to the wonderful generosity of our donors, supporters and volunteers.
Our year in numbers We supported 3,416 patients, their loved ones and the bereaved 1,260 patients supported by our Community Nursing Teams
105,672 people visited our website
329 patients cared for in our In-patient Unit
669,617 items sold in our 18 shops
338 individuals supported by Day Services
1,995 individuals helped by the Family Support Team Front Cover: Our Community Nurses see patients in their own homes
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ÂŁ207,000 raised from Gift Aid in our shops
Our shared values
The care and values define our relationships with all those we care support These we offer and support, our colleagues and the wider community.
Day Services
Community Nursing Team
Hospice at Home Service
Compassionate
In-patient Unit for Specialist Palliative Care
Family Support Services Volunteer Services
Medical Services
Caring Education and Resources Centre
Committed Spiritual Care
Professional
Outpatient facility for Consultantled clinics
Allied Healthcare Professionals
Our values Caring
Compassionate
Committed
Professional
Caring is at the heart of what we do
We work with empathy, sensitivity and understanding
We are dedicated, reliable and hard working
We aspire to be the best in everything we do
We continuously strive to deliver highquality services
We are innovative and develop our skills through continuous learning and evaluation
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
We are considerate, kind and fair We support and empower individual choice
We support each other and work together for the benefit of our patients and loved ones
We take responsibility for our actions and are accountable.
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Chairman’s reflection This review celebrates the many ways in which St Richard’s Hospice continues to care for and support our patients, their loved ones and carers at a time of increasing need for specialist and palliative end of life care. As well as continuing to provide our on-going care, we have seen further redevelopment and expansion of the hospice in phase one of our Build 2020 appeal – thanks to wonderful support from our community. The larger spaces and clinical innovations are helping us to transform the traditional day hospice model of care, with the emphasis on enabling and supporting people to ‘live well’ with their illness. This approach helps people 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 give the highest standard of care, support and compassion for everyone using our services, in order for them to experience extraordinary care. We work closely with other health professionals to provide co-ordinated care to best meet the needs of patients and their loved ones.
Our light and modern new reception
Horticultural therapy is one of the Living Well activities on offer
Thank you to all those who support St Richard’s in so many ways, ensuring we are here now and in the future to offer our care. John Bawden Chairman
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Adapted Tai Chi classes
“ St Richard’s supports my family - not just me - which gives me great comfort. “
Michelle, her husband Carl and their four daughters aged 3, 8, 11 and 21 are supported by St Richard’s. Michelle has a terminal diagnosis. Michelle: “The counselling is extremely important for me to offload. Without the counselling I don’t know where I would be at to be honest. Carl also has counselling. “A lot of stuff is really emotionally charged, and when you talk to other people you have to deal with their emotions as well. When you talk to a counsellor you don’t need to worry about their emotions, you can concentrate on your own. I remember being in the park once and thinking I’m not part of this world anymore. Everyone else was just doing
their stuff and then you can come here and work through it and find what you are feeling isn’t abnormal - you can get a bit of perspective on it.” Michelle: “The children have been so very well supported, I particularly see a massive difference in them when they come to St Richard’s to talk to the social worker or go to the Waterbugs support group with their dad. They come home looking lighter.” Carl: ”they look forward to the Waterbugs group, it helps them explore their feelings to stop them building up so much that they don’t know what to do with them. They can go and talk to a young person of a similar age who is going through the same as them and understands that shared experience.” Michelle: “For me St Richard’s is a lifeline. I know how much it supports my family, not just me, which gives me great comfort.
Michelle and Carl with their family
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Palliative care when and where it’s needed The Gateway Service is our single point of access for all referrals to ensure people receive care at the right time from the most appropriate team. Patients who would like support from St Richard’s can be referred by their GP, Consultant at the hospital, District Nurse or other healthcare professional. Our Gateway team is also available should a patient, or person close to them wish to speak to them directly for information or advice.
Help is never more than a phone call away
Our highly experienced Nurse Specialists, supported by Senior Staff Nurses, use their skills and knowledge to help manage patients’ symptoms, support them and their families and carers in making informed choices and refer onto appropriate additional services. How they are supported is determined by what the patient prefers: this can be through face to face meetings at the patient’s home, GP surgery or the hospice. Often there is a combination of face to face and telephone contact. The team works alongside other health care professionals, social service departments and other voluntary/charity organisations to ensure the patients have access to the services which may be needed to support their care. We received 1,089 community referrals
Specialist nursing advice is available 24 hours a day, every day. Our telephone advice service is available if circumstances change unexpectedly and support is needed before the next working day.
Our last CQC inspection report in 2016 gave us an overall rating of good.
Our nursing team in the community Most of our patients tell us that they would prefer to spend their last days in their own homes. This is where they feel safe and comfortable, and can spend precious time with their loved ones.
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Hospice at Home Our Hospice at Home service provides additional support which enables patients to remain in their own home at the end of their lives. The service runs 24 hours a day, seven days a week and can provide urgent overnight or daytime periods of nursing care for patients at home.
Day Services The Day Hospice has a team of multidisciplinary healthcare professionals. It runs three days each week, usually with a maximum of 16 patients per day. The Day Services Team relocated back to the newly refurbished and spacious rooms in November 2018. This has given more room 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. A daily team meeting discusses goals set by patients, implements plans of care and clear discharge plans. Patients who attend Day Hospice have an unstable or deteriorating disease that requires support with symptom control management and significant psychological and emotional support. We welcome up to 30 patients a week to our Living Well services which empower patients to self-manage their condition and promote quality of life and independence. Our Living Well courses offered: -
Adapted Tai Chi (seated) Adapted Tai Chi (standing) Relaxation Coping with illness Fatigue Management Managing your Breathlessness Art and Crafts Sharing Stories Spiritual Care Finding Inner Peace Christian Pilgrim Tree of Life Horticultural Therapy Men’s Space
The courses are open to people living with a serious progressive illness such as cancer, heart failure, chronic obstructive pulmonary disease (COPD), chronic kidney disease, Parkinson’s disease and motor neurone
disease. With many courses participants will be encouraged to practice techniques to learn how to manage symptoms at home; to help gain the maximum benefit from the course and develop confidence to continue practising once the course has come to an end. We also run social groups and information sessions for people with a serious progressive illness who do not need a referral. These are: - Knit and Knatter - M aking Life Easier Through Technology - Love Books - U nderstanding Pain and its Management
Out-patient Clinics St Richard’s works in partnership with the NHS in Worcestershire to offer patients with advanced non-malignant diseases (cardiac; renal; respiratory and Parkinson’s disease) the opportunity to attend specialist out-patient appointments at the hospice. The clinics aim to improve quality of life for patients by proactively managing their illness, and helping them and their families to plan for the future. 143 people attended our clinics
I recognise symptoms earlier and deal with them better. Having people you can call on if you need help or guidance.
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To all the staff at St Richard’s we 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.
The In-patient Unit
81% of patients are admitted within 24 hours of referral 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 those who are important to them.
This care and support is provided by a team that includes specialist doctors, nurses, chaplaincy, social workers, family support, physiotherapists, occupational therapists and complementary therapists.
Our aim is to address and help with any issues or concerns that the patient or family may have – this could be problems regarding pain and other symptoms, physical difficulties or concerns of a spiritual, social or emotional nature.
The level of care was outstanding, really could not have been any better at all - you are all amazing people in an amazing place.
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Going the extra mile Hospice care is all about improving the quality of life and well being of those with a serious progressive illness. Helping them live as fully as they can for the precious time they have left. It’s also about supporting families, close friends and carers both during a person’s illness and afterwards. Whether it’s organising weddings, throwing surprise parties or holding a patient’s hand through the night, we will be there. We will always go the extra mile.
We were honoured to be part of a very special wedding in the beautiful new hospice reception area, decorated with balloons and confetti before family members gathered to celebrate the couple’s marriage.
You are such an amazing hospice and what you did for my wife and I being able to finally marry, I will treasure for the rest of my life.
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Supporting the family The Family Support Service provides a wide range of help to patients, their families and carers including counselling, bereavement support, social work, community volunteer support, citizen’s advice and group support. Bereavement Support South Worcestershire (BSSW) is hosted by St Richard’s Hospice and supports individuals and families who are bereaved unexpectedly. Daily social work support is offered across all clinical hospice teams. Social
workers continue to attend all daily handovers, clinics and multi-disciplinary meetings in addition to providing a weekday open-door drop in service. Other activities: - Carers’ Groups - Bereavement walking group - Teenagers, children and family activity days - Men’s and Women’s Space Groups - S upport groups for adults bereaved by suicide
1,716+ Family Support referrals 2,527 one to one support sessions 4,736 telephone contacts 207 group sessions 2,032 Family Support group attendees
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£238,872 obtained for patients and families in benefits and trust fund grants by the CAB team.
Members of Men’s Space visit Spetchley Gardens.
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. A group of bereaved teenagers took part in an activity day arranged by our Family Support Team.
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Citizens Advice
Referrals to the Citizens Advice Bureau Advisers can be complex. Our advisers give an informed service to people when they are experiencing enormous challenge in their lives. Since 2009 the CAB advisers have raised more than ÂŁ1.466m in benefits and trust fund grants for our patients and families.
Community Volunteers Community volunteers provide support including companionship, shopping, housework and ironing.
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.
Feedback suggests that having a volunteer visit to provide company and a welcome break from being alone whilst facing a serious progressive illness is appreciated and has a positive impact on the individual.
Counselling, support for children and families, telephone support and group support are available for individuals and families who are bereaved through sudden and unexpected death.
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.
Members of the Sunflower Bereavement Group.
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The counselling team continues to work with patients and their families before and following the death of a loved one.
Therapies
Physiotherapy - Physiotherapy is provided for patients in the In-patient Unit and across all our day services. Exercise classes take place every day in Day Hospice. These classes are run by a physiotherapist and also by volunteer therapists and other members of the team who have received training.
475 physiotherapy referrals Occupational Therapy - Our Occupational Therapists provide a home assessment service and 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. The Occupational Therapists have provided support with a greater focus on rehabilitation in palliative care and have been actively involved in running therapeutic groups and activities for the Living Well programme. Complementary Therapies - These are used alongside standard health care and include aromatherapy, relaxation and massage. Creative Therapy - Creative Therapy is widely acknowledged as having particular benefit to patients with specialist palliative care needs so is provided here to improve emotional and psychological wellbeing. Therapies on offer include the creation of treasured memories and memorabilia for family and friends.
Spiritual care and chaplaincy The Chaplaincy Team provides support to in-patients, day patients, families, staff and volunteers. In addition, the team reaches a wider population through the many funeral services and community events they conduct. The team has also conducted blessings, weddings, funerals 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 was involved with Lights of Love and remembrance services, contributing to an estimated 4,900 people reached by community events.
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!
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Education developments 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. Project ECHO® The hospice has been fortunate to receive 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
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Staff and volunteer attendances at training sessions
194
External staff given training
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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 and with the wider NHS. The project has been made possible by our renewed information technology infrastructure.
Great session, very good delivery, right level of involvement of participant.
691 External study days, courses and conferences
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Students and trainees supported including medicine, nursing, paramedics, social work, physiotherapy and administration
Involving our community The Engagement Officer aims to widen and deepen the knowledge of St Richard’s services to increase access, awareness and involvement in end of life care. During the year the Engagement Officer involved 8,000 people in activities. 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.
Staff and volunteers promoted hospice care for all at Birmingham Pride.
The Before I Die board encouraged the community to think about death and dying in an open and friendly way.
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Our volunteers are superheroes! Our volunteers are truly remarkable and we are privileged to have more than 900 donating their time in hundreds of roles around the county. They give themselves freely, simply because they want to make a difference to the lives of others. We couldn’t continue to offer all our care without these fantastic individuals. Volunteers contributed a total of 132,027 hours. Volunteers involved in patient services worked for 26,664 hours While volunteers assist in a wide range of patient areas, their help with fundraising events; shops and commercial department and contribution within the administrative functions of the hospice are also essential.
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I love being a volunteer for St Richard’s Hospice. Even though I’m only at the St Swithins store two or three shifts a week, I feel I’m helping a great charity whilst having fun and meeting people too.
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 essential. A further consideration is the plethora of new charities in the community all seeking donor support.
Trusts and grants organisations and individuals that have committed and pledged to help us, we were able to secure funding in line with expectation. This support, along with good financial management of reserves and income from Gifts in Wills, has provided a stable foundation for the public appeal phase. 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. We are indebted to everyone who supports us.
Commercial
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.
Our strategy of increasing the size of our shops where appropriate has been completed and we have seen an increase of 19.5% on the net profit contribution to the hospice’s care services.
A £5.3m capital appeal in support of our development work is underway and during the financial year 2018/19, thanks to the
Turnover rose from £2.6m to £2.9m with the net profit contribution to the hospice of £650,000.
Thousands of supporters take part in events to help fund our care.
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Financial review This year sees the total income exceed £10m for the first time. The community’s superb response to the Build 2020 appeal is the main cause of this increase.
The financial position of the hospice at 31st March, 2019 is very strong with fixed assets additions in the year of £2.3m mostly funded by the Build 2020 income. Richard Shaw Honorary Treasurer
Other £0.305 million Shops £2.912 million
Voluntary Income £4.182 million
TOTAL INCOME £10.368 million
NHS £2.007 million
Gifts In Wills £0.962 million
Fundraising £1.038 million
Shops £2.262m million
TOTAL SPEND £9.110 million
Patient & Family Care £5.520 million
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Other £0.290 million
Year Ended 31st March 2019 INCOME £’000s Fundraising, grants, donations and events 4,182 Shops Income 2,912 Gifts in Wills 962 Education and Study Centre 80 NHS Contributions 2,007 Income from joint venture Lottery 108 Investment income 117 Total 10,368 EXPENDITURE Patient and family care 5,520 Education and study centre 258 Fundraising and publicity 1,038 Shops expenses 2,262 Cost of managing investment 32 Total 9,110 SURPLUS for year 1,258 Investment gains 264 Net increase in Assets 1,522 BALANCE SHEET (as at 31st March 2019) Year Ended 31st March 2019 INCOME £’000s Fixed Assets 12,889 Current Assets 3,548 Current Liabilities - 865 Net Current Assets 2,683 Net Assets 15,572
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Please help us to do even more in 2020. On behalf of our patients and families we would like to say a big Thank you to everyone who has supported our care.
To help us care for patients and their loved ones in the future, you can fundraise, volunteer or raise awareness of St Richard’s. For more information visit www.strichards.org.uk
St Richard’s Hospice Wildwood Drive, Worcester WR5 2QT | 01905 763963 Registered charity no. 515668. Registered company no. 01850502