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Patient Services Report and Quality Account 2016 - 2017

TABLE OF CONTENTS Mission Statement .................................................................................................................. 3 Part 1 ...................................................................................................................................... 3 Chief Executive’s Statement ................................................................................................... 3 Priorities for Improvement 2017-2018 ................................................................................. 4 Priorities for improvement 2016-2017 ................................................................................. 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 .................................................................................................................................... 11 Quality and performance review ........................................................................................... 11 Medical Team .................................................................................................................... 11 Clinical Nurse Specialist Team .......................................................................................... 12 Hospice at Home Team ..................................................................................................... 14 In-patient Unit .................................................................................................................... 17 Family Support Service ..................................................................................................... 21 Day Services and Outpatient Clinics ................................................................................. 29 Occupational Therapy ....................................................................................................... 33 Physiotherapy .................................................................................................................... 34 Education and Resource Centre ....................................................................................... 35 Chaplaincy Team and Spiritual Care ................................................................................. 37 Volunteer Services ............................................................................................................ 39 Community Engagement ................................................................................................... 39 Funding our Care .............................................................................................................. 40 Our core values ................................................................................................................. 41 Governance Structure – 1st June 2017.............................................................................. 42 What Worcestershire Clinical Commissioning Groups say about St Richard’s Hospice ... 43 What Healthwatch Worcestershire says about St Richard’s Hospice ............................... 43 2

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

Part 1 CHIEF EXECUTIVE’S STATEMENT 2016/2017 has been a year of expansion and innovation informed by the outcomes of the strategic review led by our Council of Governors. I feel privileged to be appointed Chief Executive following Mark Jackson’s retirement on 1st June 2017. Mark’s leadership has supported numerous service developments for patients and their loved ones since his appointment as Chief Executive in 2006, including many of the achievements outlined in this report. A key area of success and development for this reporting period has been the transformation of our Day Hospice that has enabled and supported people to ‘live well’ with their life-limiting illness. This approach has enabled people to gain confidence in managing their conditions supported by a range of self-care strategies tailored to their personal needs. “I cannot thank the staff, volunteers and other patients enough. Day Hospice has changed me forever and I now know what the word ‘hospice’ really means. It’s a place you come to, to learn how to live again. I think one of the best ways to describe your life when something like this happens to you is….Life is a glass vase that can shatter into a thousand pieces when dropped. You cannot put it back together again. However, Day Hospice helps you put your life back together and rebuild that vase into a new and better suited shape.” Our new Gateway service led by Clinical Nurse Specialists and a social worker has enabled co-ordinated assessments, professional support and access to our services seven days a week. This new service has provided responsive telephone advice and earlier access to our services by patients, carers and health and social professionals. We are fortunate to have staff and volunteers who continually strive to innovate and improve care and clinical services, as outlined in this report. We highly value our clinical relationships and partnership working with Health and Social Care providers, Primary Care and NHS Commissioners in Worcestershire. Working in partnership enables us to 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.

PRIORITIES FOR IMPROVEMENT 2017-2018 Future planning It must be noted that implementation of these priorities is dependent upon the ability to raise the necessary funds. Improvement Priority 1: Complete the Strategic Review implementation that will shape St Richard’s Hospice palliative and end of life care services for the next 5-10 years, including building an extension to Day Hospice. Improvement Priority 2: Continue to expand the concept of wellness into practical rehabilitative palliative care. To enable patients to live well with life-limiting illnesses. Improvement Priority 3: Continue to expand the Community Volunteers Service by recruiting and training more volunteers. Improvement Priority 4: Take over the Worcestershire Palliative Care System contract for SystmOne and achieve interoperability with the GP system, EMISweb.

PRIORITIES FOR IMPROVEMENT 2016-2017 (Taken from St Richard’s Hospice Patient Services Report and Quality Account 1st April 2015 – 31st March 2016) Summary of achievements Improvement Priority 1: Complete the Strategic Review implementation that will shape St Richard’s Hospice palliative and end of life care services for the next 5-10 years. Partially completed. Improvement Priority 2: Create the St Richard’s Gateway. Completed. Improvement Priority 3: Develop the concept of wellness into practical rehabilitative palliative care. Completed. Improvement Priority 4: Develop the workforce model for community services. Completed. Improvement Priority 5: Expand the Community Volunteers Service by recruiting and training more volunteers. Partially completed. Improvement Priority 6: Take over the Worcestershire Palliative Care System contract for SystmOne and achieve interoperability with the GP system, EMISweb. Partially completed.

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 2016/2017, accounted for 24% of the total income of St Richard’s Hospice. The totality of services St Richard’s Hospice makes available to the Worcestershire Clinical Commissioning Groups, using both NHS funding and its own charitable resources, is as follows: • • • • • • • • • • • • • •

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

The detailed achievements of all St Richard’s Hospice Services, whether paid for by charitable or statutory funds can been 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. 5

Participation in clinical audits During 2016/2017, St Richard’s Hospice took part in the national comparative audit of red blood cell transfusion in hospices, NHS Blood and Transplant. 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 2016/2017 that were recruited during that period to participate in research approved by a research ethics committee was fifteen. St Richard’s Hospice, in collaboration with University College London, is recruiting to the multicentre research study investigating the Prognosis in Palliative Care prognostic model alongside other prognostic scoring systems developed for patients with advanced cancer. Recruitment to the study began in November 2016 and is currently ongoing.

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 2016/2017. St Richard’s Hospice is subject to annual inspections by the Care Quality Commission. An on-site unannounced inspection took place on 14th and 15th March 2016, the overall rating for St Richard’s is ‘Good’.

On 27th September 2016 a planned Clinical Quality Review and Quality Assurance visit from NHS South Worcestershire Clinical Commissioning Group took place. Commissioners received an update from our Family Support Team on safeguarding and were presented with the evaluation study of GP perception of St Richard’s from our medical team. In addition they received assurance of our antibiotic stewardship and compliance with sepsis guidelines. The Commissioners spoke with staff, relatives of patients and patients. Overall, a good level of assurance was obtained.

Data Quality St Richard’s Hospice did not submit records during 2016/17 to the Secondary Users Service for inclusion in the Hospital Episodes Statistics which are included in the latest published data. Information Governance Toolkit St Richard’s Hospice attainment score for 2016/2017 for Information Quality and Records Management was assessed against the Information Governance Toolkit and scored 65%. This was 1% short of the 66% required to achieve a satisfactory score. The submission is a requirement under the terms of our NHS Contract. June Patel Chief Executive

OUR COMMITMENT TO CLINICAL QUALITY, PATIENT SAFETY AND DIGNITY Achievements in 2016/17 St Richard’s Hospice continually strives to improve the standard of care experienced by patients and families. We pride ourselves on reviewing the quality of services delivered and in identifying and acting upon any areas that could be further improved. The monitoring of quality is undertaken by the Care Quality Sub-Committee which reports quarterly to the Hospice Services Committee, which is a sub-committee of the Council of Governors. The Care Quality Co-ordinator supports clinical staff in the measuring and reporting of care quality in their specialist areas. This enables an overview of standards of care across the whole organisation. Care Quality Sub-Committee: its role in safeguarding clinical quality and safety Our continual review of quality of care provided is owned by the clinical teams and led by members of our Care Quality Sub-Committee, comprising the Clinical Heads of Department, Care Director, Medical Director, two Governors and the Care Quality Co-ordinator. For this reporting period the Care Quality Sub-Committee has:

• • • •

Completed an annual review of the baseline audit of evidence against the CQC inspection regime Ratified clinical policies and devised a clinical policies review programme for 2017/2018 Devised a clinical audit programme for 2017/2018 Reviewed evaluations returned from patients and families which confirm that teams consistently perform well, and all comments and suggestions are considered by the group.

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

Complaints: Three complaints were received for this reporting period. All complaints were fully investigated by the Care Director 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 175 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 our St Richard’s Facebook page posts have received over 91,000 likes.

During the reporting period 1st April 2016 – 31st March 2017 there were 267 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 53 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. 48 patients were found to have pressure ulcers prior to admission. The risk of pressure ulcers developing can be reduced by ensuring good hygiene and skin care, monitoring of nutritional intake and regularly repositioning the patient. The Tissue Viability Lead Nurse reviews all pressure ulcers and any ulcers of grade 3 or above are fully investigated to identify root causes. Of the 17 pressure ulcers acquired within the hospice, two grade 3 pressure ulcers developed and were reported to the

CQC and Commissioners. Each case was fully investigated and both were found to be unavoidable. •

Medication errors: 11 out of the 22 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. Two incidents were reported as near miss incidents to enable further learning to take place.

•

Infection Control: There were no incidents of Methicillin-resistant staphylococcus aureus (MRSA) and four incidents of Clostridium Difficile (C.Diff) during the reporting period. There were six incidents of Vancomycin-resistant enterococci (VRE), the patients were colonised with the infection prior to admission to the In-patient Unit. The Infection Control group is proactive in completing annual audits, which are led by two infection control link nurses.

•

Safeguarding: Care plans for people who lack mental capacity to agree to arrangements for their care or treatment should show evidence of a best interests decision, in accordance with the Mental Capacity Act 2005. Additionally in some cases, due to the level of care and supervision provided an application for authorisation for Deprivation of Liberty Safeguards must be made to the local authority. During the period of April 2016 – March 2017, 13 applications for Deprivation of Liberty Safeguards were made by St Richard’s Hospice. A wide range of patients and their families come into contact with services provided by St Richard’s Hospice. Whilst accessing services, and unrelated to care provided by St Richard’s Hospice, our staff identified four Vulnerable Adult incidents that resulted in referral to the Safeguarding team at Worcestershire County Council for specialist Social Worker review.

•

Other incidents: During this reporting period there were 88 incidents categorised as ‘other’. Each incident was followed up in line with St Richard’s Hospice incident reporting policy. The incidents did not result in any adverse outcomes to patients.

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

Infection control audits Pressure ulcer audits Peer support audit 9

• • • • • • • • •

Blood transfusion audit Community nurse medicines policy audit Complementary therapy policy audit DNACPR decisions audit Care of patients with pancreatic cancer audit Antimicrobial stewardship audit Acupuncture audit Medicines management audits Medical gases 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 Consultant, Dr Nicola Heron, who leads the Worcestershire Royal Hospital palliative care team. The hospice Medical Director works in partnership with the other consultants in palliative medicine in Worcestershire to ensure that specialist palliative medicine advice is available to professionals 24/7. In addition, we have a team of interested local GPs who contribute to the provision of on-site medical cover at weekends. The hospice supports its doctors to maintain their continuing professional development and to meet the requirements of appraisal and revalidation, as required by the General Medical Council. In addition to hospice annual internal performance reviews all doctors also participate in externally provided and quality-assured medical appraisals for revalidation. The hospice is a designated body for revalidation with Responsible Officer services provided by the Medical Director of the HACW through a memorandum of agreement. Two doctors currently have a prescribed connection to St Richard’s Hospice. There have been no complaints or concerns raised about the practise of these doctors. Patient and carer feedback The medical team receive frequent verbal and written appreciation from patients and carers. However, we are always keen to seek ways in which we can improve and request formal evaluation from bereaved relatives after a loved one has died on the In-patient Unit. In 2016/2017, 70/70 (100%) rated the medical care as excellent/good. “I will always be grateful for the professional, loving (never condescending) care given to us both. In particular I must mention the great help and kindness given by I think Becky, in the final hours. You should be proud of everyone - cleaners, nursing staff and doctors.” (April 2016) “The calm, caring, patient centred approach, allowing Dad to sleep when he wanted and eat and drink when he wanted - the availability of the ice lollies which he craved in the last 48 hours. The approach of the doctors and nurses and the fact that they had time to talk to Dad as an individual and took genuine interest in him. The family support after Dad died. As a family we take great comfort from the fact that Dad died at St Richard's.” (May 2016)

CLINICAL NURSE SPECIALIST TEAM The St Richard’s Community Nursing Team is highly experienced and staff are able to use their skills and knowledge to help manage patients’ symptoms, support them in making informed choices and identify and refer onto appropriate additional services. The Clinical Nurse Specialists tailor their support to individual needs so patients may be seen at home, in GP surgeries, at a clinic or at the hospice. Some patients choose to be supported by a regular telephone call rather than a visit. Working with other health teams, including GPs and District Nurses, our Clinical Nurse Specialists will visit patients to offer advice on managing physical symptoms such as pain, nausea or fatigue. They will spend time listening and identifying problems and anxieties and support each individual or family to find ways of dealing with these. A regional forum of Queen’s Nurses has met at St Richard’s Hospice and been supported by one Clinical Nurse Specialist and the Community Nursing Services Team Leader. This is an active group which feeds back to the national Queen’s Nursing Institute on key issues affecting community services. In addition, the team have been active within a recently formed health economy clinical learning forum. This forum brings together front line clinicians from all sectors to explore opportunities for joint working to support patient care. The initial meetings focused upon the crucial role of continuing health care funding with key learning identified and an action plan formulated. In November, the team presented two posters for the annual Hospice UK conference and the community team leader presented her work on economic assessment of nursing innovations. The community nursing services manager has successfully completed a level 5 Institute of Leadership and Management (ILM) qualification in mentoring and coaching. These skills have already been put into use in the management role.

St Richard's Hospice Nurse Specialists Community Referrals 120 100

80 60

105

89 90 75

104

102

Dec

Jan

92 79

86 75

40 20 0

Apr

May

Jun

Jul

Aug

Sep

Oct

2015/2016: 967

Nov

Feb

Mar

2016/2017: 1,065

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

100

200

300

400

500

Worcester

493

Droitwich

165

Malvern

147

Evesham

118

Pershore

Broadway Tenbury Wells

600

24 2

Other

Total referrals: 1,068

South Worcestershire Referrals By Postcode Districts 180

Total referrals: 1,025

165

160

140

124

120

102

100 54

60 20

80 40

133

118

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

St Richard's Nurse Specialist Community Contacts 4,500

Oct

2015/2016: 24,817

2,935

Sep

2,007

2,803 1,876

Aug

Nov

2,206 2,678

Jul

2,136 2,364

Jun

2,186 2,686

May

2,093 2,427

Apr

2,335 2,559

2,296 2,688

500

2,083 2,790

1,000

1,838

1,500

1,652

2,000

3,294

2,500

2,109

3,000

3,846

3,500

3,632

4,000

Dec

Jan

Feb

Mar

2016/2017: 34,702

Patient and carer feedback “Our family had a gift from heaven when your nurse came to us to look after Mum. She is an angel sent from the stars, she went beyond every call of duty to make sure my Mum understood and managed her cancer. I on behalf of my family thank you all from the bottom of our hearts for everything you have done for us”. (September 2016) “Of all the people I want to thank, you are at the top of my list. We didn’t have all that long to get to know you, which is one of the reasons I find it even more special how close you got to us. Dad always did things his way and made his wishes clear. Nearer the end he felt a little less control as he got weaker. He relied on me to be his voice but I was crumbling. Then you appeared at my side and made us strong again. His last day was so hard but you made it a little bit easier. I knew I wasn’t alone”. (December 2016)

HOSPICE AT HOME TEAM 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. The experienced nursing team works closely with GPs and District Nurses to provide additional care to help patients remain at home; providing physical and emotional support to patients, their carers and loved ones. Experienced Healthcare Assistants provide nursing care to prevent unnecessary admissions to hospital, particularly if the patient wishes to remain at home during the last few days of life. The service is available as a short term package of care when patients are most in need – when they are very ill and in the final stages of their illness.

The team support patients following discharge from the In-patient Unit or to those patients being cared for at home whilst they are waiting for admission to an In-patient Unit bed. This close working with the In-patient Unit aims to prevent unnecessary admissions to alternative care environments. The team has been supporting their first full time student nurse placement from the University of Worcester. This is a new initiative which aims to give a student an insight into community specialist palliative care. The Hospice at Home Team Leader is the identified mentor for this student. The team leader has attended the National Association of Hospice at Home conference in Bristol supported by one of the Healthcare Assistants. A poster presentation outlining medicines management within the Hospice at Home service was well received. The Hospice at Home Team Leader has supported a research study in collaboration between the University of Kent, Surrey and Cambridge, Pilgrims Hospices, the National Association for Hospice at Home and NHS England supported by Hospice UK: â€˜Hospice at Homeâ€™ Services for End of Life Care (OPEL Study). The study is exploring how Hospice at Home services across the country work. The team leader is working collaboratively with the Continuing Health Care team to explore solutions to support packages of care in the community.

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

31 31

35 35 30 29

32 25

Apr

May

Jun

Jul

Aug

Sep

2015/2016: 366

Oct

Nov

Dec

2016/2017: 380

Jan

Feb

Mar

Hospice at Home allocations 350

300

292

250 200 150

287

282

252 196 178

160168

181 168

238

196202 148

100

131

220 208 212 195

239 174174

162

111

50 0

Apr

May

Jun

Jul

Aug

Sep

2015/2016: 2,143

Oct

Nov

Dec

Jan

Feb

Mar

2016/2017: 2,631

Hospice at Home: Number of Individual Patients Supported Monthly 80

60 40 30 20

40 41

Apr

May

56 45

59 40

55 38

10 0

Jun

Jul

Aug

Sep

2015/2016: 510

Oct

Nov

Dec

Jan

Feb

Mar

2016/2017: 656

Patient and carer feedback “My husband died at home and the help provided by the St Richard’s at home team in the preceding weeks proved invaluable. I cannot speak highly enough about it. I was and am extremely grateful for the unselfish love and special care shown towards both him and myself at such a pivotal time of vulnerable need.” (May 2016) “Thank you so much for making it possible for us to have a few days away as a family, you have no idea how much it means to us all.” (July 2016) “I am writing on behalf of my family to say a big thank you for the care and support Dad received, can you pass on our thanks to all the staff, both day and night; they made such a difference, they helped us to keep Dad at home which was his last wish. We send you our best wishes”. (February 2017)

IN-PATIENT UNIT In April, the In-patient Unit Manager developed a dependency scoring tool, adapted from established validated dependency scoring tools. The tool enables the holistic domains of care to be included and has been found to demonstrate the intensity of each patientâ€™s care needs. The tool also demonstrates the complexity of patient and family needs on the Inpatient Unit. The scoring tool has been included in the SystmOne electronic patient record. The In-patient Unit nursing staff use the tool daily for all their patients, allowing reports of changes in individual dependency scores and a picture of the overall dependency levels of patients on the ward at any one time. Also in April the Hospitality Service was introduced on the In-patient Unit. A team of volunteers, led by the Hospitality Co-ordinator, work seven days a week to deliver the personalised service. A member of the Hospitality Team visits each patient in the In-patient Unit mid-morning to talk them through the choice on the three-course menu for the day. Patients are able to enjoy their favourite foods, and the staff are able to liaise with the catering staff to support the patients clinical needs. In addition, the new hospitality team gives nursing staff more time to spend on patient care. In-patient Unit Admissions 40 35 25

30 26 25

28 27

30 25

26 22

Dec

Jan

25 21

10 5

Apr

May

Jun

Jul

Aug

Sep

2015/2016: 339

Oct

Nov

2016/2017: 312

Feb

Mar

In-patient Admissions by Postcode Town: South Worcestershire - 265 45

Worcester

Droitwich 23

Evesham

Malvern

135

Pershore

Broadway Tenbury Wells

In-patient Admissions by Postcode Town: Other - 47

Kidderminster

Stourport-on-Severn

Bewdley 3

21 1

Redditch Birmingham Bromsgrove East Sussex Hereford Ludlow Stourbridge

Age Count by Admission 100 90 80 70 60 50 40 30 20 10 0

94 38

Under 16

312 Admissions

16-18

2 2

19-24

25-64

65-74

Male

Female

44 56

21 23

75-84

85+

Time between referral and admission: Apr 2016 - Mar 2017 Number of Admissions

140 120

105

100

120

80 60

40 20 0

Days since referral

In-patient Unit Weekend Admissions 9 8

5 4 3 2 1 0

4 3 2

Apr

May

Jun

Jul

Aug

3 2

Sep

2015/2016: 43

3 3

Oct

Nov

Dec

Jan

2016/2017: 30

Length of Completed Stays - Admission Count 140 120 100 80 60 40 20 0

140

42 22

<= 1 1 - 2 Week Weeks 2 - 3 3-4 Weeks Weeks 299 Completed admissions 13 Admissions ongoing

4-5 Weeks

5-6 Weeks

+6 Weeks

Feb

Mar

Cancer Diagnosis by Admission: 269 14

Digestive Organs

6 5

Respiratory & Intrathoracic

Breast

Other Specified Sites

Lymphoid / Haematopoietic

Female Genital Organs Urinary Tract

Male Genital Organs 20

Ill Defined, Unspecified

44 26

Lip, Oral Cavity & Pharynx Eye, Brain & Other CNS

Non-cancer Diagnosis by Admission: 43 2

Chronic Respiratory Disease

Heart Failure

End Stage Renal Failure Dementia Organ Failure

Motor Neurone Disease Other Non Cancer Diagnosis Degenerative Nervous System Diseases

Peripheral Vascular Disease

Patient and carer feedback “Knowing that my wife was in a place of calm professionalism and that whatever she needed was available for her. It relieves the stress of those closest to the patient”. (June 2016) “Learning that there is a haven of help and care when one is dealing with what is a very difficult situation. It was an eye opener to us and you should all be exceptionally proud of what you do and the professional way you go about every aspect”. (September 2016) “All the staff were so kind and friendly. The Hospice is the best place he could have spent his last weeks and he died with dignity. Kindest thoughts to you all”. (March 2017)

FAMILY SUPPORT SERVICE The Family Support Service continues to provide a wide range of support to patients, their families and carers including Counselling, Bereavement Service, Social Work, Citizens Advice and group support. In June, during Carers Week, the team showcased the work undertaken with carers by inviting patients’ families to a tea party. More than 90 carers attended the 2016 event. 15 year 10 pupils visited the hospice in June; they had a formal talk on hospice work and met with a client who was bereaved, they were encouraged to ask questions regarding the family’s experience. A comprehensive tour of the building gave them insight into the work undertaken and of the environment. During the visit, they wrote down one word describing their expectations and they were then asked to repeat the exercise at the end of the visit. It was clear that their expectations were different from the reality of experiencing a hospice. The pupils came to the hospice to showcase their work to staff, volunteers and Governors later in the year. The potential for an increased understanding of death within the younger generation is crucial to demystify hospice work. A more balanced and healthier view of death, dying and bereavement is to be encouraged. The Family Support Volunteers continue to offer pre-death support to our patients and bereavement support to our patients’ families. Family Support Volunteers have supported clients on a one to one basis as well as helping to co-facilitate groups. Provision of support to the In-patient Unit has continued and patients have been supported by volunteers for a variety of needs. The manager of the Family Support Service was invited to attend a focus group with Hospice UK, to discuss the processes around supporting carers of patients at end of life. This followed a national research project where the Carer Support Needs Assessment Tool (CSNAT) was used. A facilitated discussion took place between a number of hospices. We were pleased to be included and asked to participate as the hospice is particularly good at supporting the carers and families of patients. Representatives from the Family Support Service attended the 2016 Hospice UK Conference in Liverpool during this reporting period. The team showcased three posters and delivered a presentation on the development and facilitation of a group for adults bereaved by suicide. The delivery of our Caring with Confidence programme in partnership with Worcester Association of Carers finished in November 2016. The aim of the sessions was to equip our carers to support their loved ones as well as looking after themselves. Session titles included Caring and Me, Caring - the practicalities and Caring and Communicating. Referrals were particularly high during March. This reflects the referrals received for the Teenage Activity Days and Children and Families Activity weekends for this summer as well as other groups which are planned. A grant for £7,852 has been awarded by BBC Children in Need enabling the team to provide these weekends. The National Bereavement Directory developed by the Family Support Service is being revised and updated; it will continue to be 21

available to the general public via the St Richard’s Hospice website. The team worked together with the Day Hospice and Clinical Nurse Specialist team to create a memory quilt for a family who had very specific needs. One of St Richard’s Hospice Counsellors has achieved a certificate in Psychological Trauma from Chester University and all of the team are active in attending Continuing Professional Development (CPD) events to keep their knowledge fresh and current. Counselling Referrals 40 35 30 25

28 23

26 21

34 29

29 24

23 23 23

32 27

27 22 22

15 10 5 0

Apr

May

Jun

Jul

Aug

Sep

2015/2016: 320

Oct

Nov

Dec

Jan

Feb

Mar

2016/2017: 300

Counselling client feedback “The sessions have helped me accept that life will never be the same and that life will be different but still good”. (May 2016) “I was not sure at the start of my sessions how it would help me. I was so upset but as always St Richard’s came through from the very start of my partner coming to the Hospice, dying at home, and me having to deal with things. Being able to talk and express my feelings was so good for me and I thank you all from the bottom of my heart.” (October 2016)

Family Support Referrals 250

200 184

150 100

155

148

125

181

116 119

112

107

118

115

114

110

102

172

154

145

127

178

131

111

126

199

134

50 0

Apr

May

Jun

Jul Aug Sep 2015/2016: 1,480

Oct Nov Dec 2016/2017: 1,803

Jan

Feb

Mar

Family Support Caseload 800 700 600 400 300

409

618

617

613

500

444

446

714

678

440

407

707

419

693

455

702

689

441

462

688 493

727

682 506

532

200

100 0

Apr

May

Jun Jul Aug Sep 2015/2016: Ave. 454

Oct Nov Dec 2016/2017: Ave. 677

Jan

Feb

Mar

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

756 132 388

787

777

118

115

401

388

560 92 286

236

Apr 2016

268

855

780

274 182

629

138

111

423

665 114

122

618

458

118

387

310

208

775

219

164

421

330

195

May Jun Jul Aug Sep Oct Nov 2016 2016 2016 2016 2016 2016 2016 Telephone: 4,438 Face to Face: 2,613

174

640

182

166

370

276

260 170

791

198

239

Dec Jan Feb Mar 2016 2017 2017 2017 Other: 1,582 Total: 8,633

The Senior Social Worker has attended the trauma informed care training programme at Worcester University which will be influential in developing the team’s responses to patients and families who have experienced traumatic events leading up to their contact with the hospice. One social worker attended a motivational interviewing training day to enhance assessment skills. A full day’s training developed by the Senior Social Worker for clinical staff on integrating the Mental Capacity Act / Deprivation of Liberty Safeguards into clinical practice within the hospice has been delivered to clinical staff as part of the mandatory training programme. The safeguarding mandatory training has now been revised to meet competency standards for both child and adult safeguarding and the first two sessions for paid staff have now been delivered in this year’s rolling mandatory training programme. Two sessions for new volunteers have also been provided by the Social Work team. Family Support client feedback “My Family Support Volunteer was excellent. I was able to discuss my feelings with a completely neutral person. I was able to rant and cry as I felt but was steered down avenues that I would not have gone down by myself which was really helpful to explore.” (October 2016) “I wanted to thank you again for turning out on New Year’s Day, so that I could visit the quiet room and gardens. Your help and kindness helped me a lot on what was a difficult day. It reminded me again what a wonderful place St Richard’s is.” (January 2017) Citizen's Advice Bureau £'s obtained for clients 2016/17

£153,333

2015/16

£186,362

2014/15

£109,186

2013/14

£226,024

2012/13

£105,131

2011/12

£103,818

2010/11

£68,930

2009/10

£57,554

50K

100K

150K

200K

250K

Family Support group work has experienced an increase in the number of clients attending groups supported by St Richard’s and Bereavement Support South Worcestershire. Group work for children continues to grow substantially. Meetings have taken place to plan further Teenage Activity days and Children and Families Activity weekends, and a bid to ‘Children In Need’ has been made to support this work. Waterbugs, our pre-death group

for children and the well parent/carer, has continued to take place on the second Monday of every month. It is being well received by children and parents, and is appealing to a wide age range of children (attendees ages range from 7 to 16 years old). The group is facilitated by a Social Worker and supported by staff from other teams in the hospice in addition to Family Support Volunteers. Three families attended the â€˜Inside Outâ€™ group, a group for children bereaved by suicide. Six planned sessions were completed and evaluated very well. This was a substantial achievement as work with this client group can be extremely challenging. Both the children and adults expressed benefit from meeting others in the same situation. Due to the number of referrals we received in the lead up to Christmas, the team facilitated a series of Christmas preparation sessions for bereaved clients. The aim was to engender mutual support and to equip clients with practical coping strategies to help them through what can be a very difficult period. Christmas parties took place for our Steps Group, Carers Group and Walking Group where clients enjoyed a festive meal together. Family Support Groups Sessions 18 16 14

12 9

11 9

8 6

10 8

11 11

Aug

Sep

13 11

8 6

2 0

Apr

May

Jun

Jul

Group Sessions 2015/2016: 105

Oct

Nov

Dec

Jan

Feb

Mar

Group Sessions 2016/2017: 143

Family Support Groups Attendees 300

250

245

200 150

156

100 50 0

123

90 60

Apr

May

Jun

Jul

146

135

127

106

Sep

Attendees 2015/2016: 985

Oct

111 119

Nov

Dec

Jan

Attendees 2016/2017: 1,678

138

157

129

144

Aug

138

Feb

Mar

Group session client feedback “Remembering doesn’t have to be sad” Children’s Activities weekend (August 2016) “I really enjoy coming to this lovely group, the ladies and gents are very nice and the staff are very supportive.” (September 2016) “This group was a lifeline to me. I have benefitted enormously from the one to one counselling but I needed this group to move me to the next stage. The facilitators were great, so supportive and understanding.” Client attended the Sunflower Group (November 2016) The Community Volunteers Service was invited to participate in initial discussions around Compassionate Communities. This initiative was hosted by the local NHS. It was a productive meeting and showcased the fantastic work already being undertaken by our Volunteers. The service Co-ordinator attended the Befriending Managers Meeting hosted by Marie Curie West Midlands at their Solihull hospice. This was a great opportunity for networking and sharing good practice. The Community Volunteers have helped patients and their families to care for pets, not just during the day but also providing respite overnight if patients have been admitted into the Inpatient Unit or into hospital. Another example of support is in writing letters of thanks to family and friends. The Community Volunteers Coordinator attended the Malvern Hills Forum; this is a networking opportunity as it was well attended by local charities and organisations who also work closely with volunteers. Community Volunteer Referrals 15

16 14

10 8

7 7

10 10 10 8

4 2

8 8

Apr

May

Jun

Jul

Aug

Sep

2015/16: 113

Oct

Nov

2016/17: 81

Dec

Jan

Feb

Mar

Community Volunteer Activity Sitting 54.6%

Companionship 28.8% Shopping 5.2% Housework 4.0% 17

178

13 6

Dog walking 3.4% Gardening 2.1% Ironing 1.8%

Community Volunteer Hours Provided 600

526

500

400 300 200

218

159

106

100 0

Apr

May

Jun

Jul

130

126

120

Aug

Sep

Oct

148

Nov

126

136

130

Dec

Jan

Feb

Mar

The significant increase in Community Volunteer hours in June was due to the team supporting the care of a patient’s dog. This was for a period of sixteen days whilst the patient was admitted for symptom control. Community Volunteer feedback “I love writing and receiving letters and having the volunteers gentle input and help has made a real difference to my life as I can write and thank people.” (September 2016) “The Community Volunteer Service has been fantastic for people like my mother who are lonely.” (January 2017) Following the nomination for the Wychavon Community Recognition Awards the committee stated: “The comments on your nomination form were extremely positive and highlight that you truly deserved recognition for all your commitment and dedication in helping your local community.” (March 2017) 27

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

23 15 7

Apr

May

22 10

Jun

Jul

Aug

Sep

2015/16: 317

Oct

Nov

Jan

Feb

Dec

Mar

2016/17: 102

Clients Supported by Bereavement Support South Worcestershire: 2016/17 180 160 140 120 100 80 60 40 20 0

119 72 78 69

Apr

110

May

Jun

Jul

155

149

143

Aug

145

136

126 85

160

142

104

Sep

2015/16: 941

Oct

Nov

Dec

Jan

Feb

114

119

121

Dec

Jan

Feb

Mar

2016/17: 1,551

Clients Supported by Bereavement Support South Worcestershire: 2016/17 180 160 140 120 100 80 60 40 20 0

19 13

Apr

May

124

131

130

129

Aug

Sep

Oct

Nov

100

Jun

Jul

Adults: 1,346

Children: 205

141

Mar

One of the Bereavement Support South Worcestershire counsellors has attended a Creative Short Term Therapy Course and another has completed his Couples Counselling training. Bereavement Support South Worcestershire Counselling service user feedback: “My counsellor was friendly, understanding and supportive. She turned my negativity into a healing positivity, in a few short weeks”. (April 2016) “The counsellor was so helpful and she helped me so much with the death of my husband, I will be so grateful for everything she has done for me”. (September 2016) “I was fortunate to work with a totally professional counsellor who explained what grief and emotions were. This helped me to come to terms with my loss. I came looking for answers to questions, where there were no answers. My counsellor never judged me or advised me on what to do but worked closely with me which helped me greatly”. (March 2017) Bereavement Support South Worcestershire Child and Young People service user feedback: “Thank you so much for helping me. It has helped a lot being able to talk to someone in a comfortable environment while doing creative things I enjoy”. (May 2016) “Thank you for seeing my daughter. I’m sure you all don’t get enough credit for what you do, but we want you to know how much you are appreciated”. (August 2016) “We’d just like to say a big ‘thank you’ for everything you’ve done for our family. We think you are amazing”. (September 2016)

DAY SERVICES AND OUTPATIENT CLINICS Day Hospice can accommodate 20 patients per day Tuesday to Friday. There are frequent patients who do not attend some of their allocated days due to the nature of their illness and disease progression. There is now a daily Day Hospice multidisciplinary team meeting on Tuesday, Wednesday and Thursday mornings, 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. More than half the patients who attend Day Hospice have an unstable/deteriorating disease that requires support with symptom control management and significant psychological and emotional support. In April, Day Hospice had a protected staff training day. The objectives of the protected day were to allow the team to consolidate learning and familiarise themselves with changes going forward, not only within the team but throughout the hospice. Following the 2015 strategic review the Day Hospice Team has been working hard to design a new service model in Day Hospice. The strategy paper highlighted the need to respond to an ever increasing demand by patients and to explore support of patients earlier on within their disease trajectory. The paper outlined the need to re-model and expand Day Hospice in 29

order to develop a wellness model; its philosophy will be to empower patients to selfmanage their disease and promote quality of life and independence as much as possible. As part of this development, Friday Day Hospice has become a ‘Living Well’ day, providing a programme of specific courses i.e. ‘Living Well’ courses. Following a holistic assessment from the Nursing Team, there is joint agreement with the patient on suitable sessions to attend, which are tailored to the individual’s needs and wishes if deemed appropriate by the health care professional. The Complementary Therapy Team has also been involved with the new ‘Living Well’ service plans in Day Hospice. Ideas have been discussed and the service has identified the need for a more flexible approach by offering one off sessions rather than a set course of treatment. The pilot of the ‘Living Well’ programme commenced on Friday 7th October 2016. The courses were designed to enable patients to have choice, independence and empower them to self-manage their illness. The programme consisted of eight courses: • • • • • • • •

Tai Chi (seated) Tai Chi (standing) Relaxation Positive Living Fatigue Management Breathlessness Art and Crafts Sharing Stories

All members of the Day Hospice team planned, designed and co-facilitated the courses with multidisciplinary team members in support. The six-month pilot from October 2016 - March 2017 received referrals internally whilst the Living Well Team gained confidence with the project. A full evaluation of the project took place at the end of March and recommendations were shared with the wider hospice team.

Day Hospice Attendance: Average 168 per month 300 250

200 150

221

245 213

182

178

162

100

153

168 124 84

50 0

156

138

Apr 2016

May 2016

Jun 2016

Jul 2016

Aug 2016

Sep 2016

Oct 2016

Nov 2016

Dec 2016

Jan 2017

Feb 2017

Mar 2017

172

173

124

138

156

Jan 2017

Feb 2017

Mar 2017

Total Attendances: 2,024

Day Hospice Attendance 350

278

300 250

228

200

182

150 100

313

221

252 74

245

178

266 53

213

Apr 2016

May 2016

Jun 2016

Jul 2016

Places Taken: 2,024

Aug 2016

162

Sep 2016

214

182

50 0

213

110

153

168

Oct 2016

Nov 2016

26 84

Places Declined: 577

Dec 2016

200

Places Offered: 2,601

Day Hospice Attendance by Individuals 90 80 70 60

79 80

63 62

67 56

63 60

63 47

10 0

Apr

May

Jun

Jul

Aug

Sep

2015/16: Average. 67

Oct

Nov

Dec

Jan

2016/17: Average 59

Feb

Mar

Living Well Sessions - Attendance Summary: 530 60 50 40

Did Not Attend

17/03

10/03

24/02

17/02

10/02

06/01

16/12

09/12

02/12

25/11

Attended

28 28 26 23 27 19 15

03/03

03/02

27/01

20/01

13/01

18/11

04/11

28/10

21/10

14/10

21 20 22 23 18 19

07/10

11/11

Cancelled by Patient

The consultant led, multidisciplinary, hospice clinics for people with advanced non-malignant diseases (cardiac; renal; respiratory and Parkinsonâ€™s disease) continue to evaluate well with patients and families. We are grateful to NHS South Worcestershire Clinical Commissioning Group for continuing to fund the clinics and to specialist clinicians from the NHS Trusts for collaborative partnership working. Outpatient Specialist Palliative Clinic Attendance: 275 30 25 20 15 10 5 0

6 5

5 9

Apr

16 5

May

Jun

Jul

Aug

24 21

Heart Failure Clinic

Sep

Oct

Nov

Respiratory Clinic

Dec

Jan

Feb

Renal Palliative Clinic

Mar

Parkinson's Clinic

Outpatient Specialist Palliative Clinic Attendance: 2015/16 Vs. 2016/17

35 30 25

20 15

17 13

23 22

25 24

24 25

5 0

Apr

May

Jun

Jul

Aug

Sep

2015/2016: 267

Oct

Nov

Dec

Jan

Feb

Mar

2016/2017: 275

Day Hospice evaluation feedback: “The best thing about attending Day Hospice has been the support from everyone. I have been given courage to live life again”. (December 2016) “I would like to thank everyone for their support and care during my husband's illness. He loved coming to Day Hospice and I'm sure it offered him a space where he could be the man he was before his illness. His final months were truly enriched by his time at the hospice. You are all very special people and as a family we will never be able to thank you all enough”. (December 2016) “My one day a week of change of environment, meeting fellow patients with similar life threatening illness and discussing options with very helpful staff”. (February 2017)

OCCUPATIONAL THERAPY In order to provide a more proactive and timely service to all areas it was decided to have dedicated occupational therapists for each area within the hospice on specific days. In this way, the occupational therapists could introduce patients and families to the service earlier, establish better rapport and prevent needless struggling by patients and crises happening. The occupational therapists have continued to provide support, a greater focus on rehabilitation in palliative care and have attended meetings to ensure the approach continues to be piloted and explored in all areas. The occupational therapists have been actively involved in advising on therapeutic groups and activities for the new Wellbeing Day for Day Hospice. Home visits take up a large proportion of the occupational therapists’ time. These are a necessary part of the role and are required to ensure patients’ safe and timely discharge from the In-patient Unit; to support patients with their independence and safety at home, and 33

to enable safe transport for patients attending Day Hospice. On home visits for In-patient Unit patients in addition to advice regarding equipment needed to maximise patients’ independence, families often require reassurance regarding discharge plans and assurance that sufficient care will be provided to support them and the patient in the critical forthcoming weeks.

PHYSIOTHERAPY Physiotherapy referrals continue to come predominantly from the In-patient Unit and Day Hospice. Some complex Outpatient referrals have been seen for patients who are not able to receive a service from the community physiotherapy teams. Patients who attend the exercise classes are no longer counted in the physiotherapy figures as these classes are now taken by volunteer therapists and other members of the team who have received training as well as the physiotherapists. Assessment prior to exercise is always undertaken by a physiotherapist. The physiotherapy teams have continued their links with the West Midlands regional group, Association of Chartered Physiotherapists in Oncology and Palliative Care (ACPOC) group, attending joint meetings at other hospices. The last meeting gave opportunities to discuss group wellbeing sessions and how these are planned to inform the developments taking place in St Richard’s Day Hospice. There has been a change in staffing structure which is now fully imbedded with staff generally working in individual areas to give continuity of care but also to provide cross cover when required. With no additional resources the raised awareness of the physiotherapist’s role in palliative care has led to additional patients being referred and an increase in the number of overall treatments. Physiotherapy Referrals 40 35

30 25 20 15

21 17

5 0

Apr

May

Jun

27 22

25 21

12 8

Jul

Aug

Sep

2015/2016: 240

Oct

Nov

Dec

2016/2017: 305

Jan

Feb

Mar

2015/16: 2,983

Physiotherapy Treatments: 2015/16 Vs. 2016/17 0

250

500

750

1000

1250

1500

325

Mobility Assessment Functional Assessment

141 132

Breathing Control

96 129

1909

552

141 206 62 134

Exercise class

90 160

Moving and handling assessment Clearance of secretions of respiratory tract

58 83

Pain relief

61 99

Teaching

2250

37 50

Referral to physiotherapy service

Provision of medical equipment

2000

358 378

Exercise Therapy

Advice about exercise

1750 1545

Physiotherapy

Acupunture for Analgesia

2016/17: 3,934

26 34 40 64 3 4

EDUCATION AND RESOURCE CENTRE St Richard’s Hospice is passionate about supporting palliative and end of life education and training for staff, volunteers and the health and social workforce in Worcestershire. We continue to provide specialist palliative and end of life care clinical placements to: • Medical students from University of Birmingham • Student Nurses from the University of Worcester • Student Physiotherapists from the University of Worcester • Student Occupational Therapists from the University of Worcester • Student Social Workers (from a range of universities) • Student Counsellors (from a range of higher and further education providers) • Palliative Medicine specialty training - St Richard’s continued to provide placement and educational supervision for a senior (ST6) palliative medicine trainee. The Medical Director is a member of the regional Specialty Training Committee, meeting quarterly, and assisted with national recruitment of specialty trainees in March 2017. • Junior doctor training – St Richard’s continued to participate in training rotations for the Foundation and GP training programmes. 35

During this year we have hosted two Sri Lankan Medical Fellows (in collaboration with the University of Worcester, the Royal College of General Practitioners and the University of Colombo). The first Fellow completed a placement at St Richardâ€™s at the end of February 2017, with excellent feedback about the learning opportunities provided by the placement. A project was completed evaluating the prevalence of opioid induced constipation on the Inpatient Unit and investigated the financial implications of using the NICE-approved medicine Naloxegol for these patients. This project has been accepted as a poster at the RCGP Midland Faculty Annual Education, Research and Innovation Symposium at Warwick University in May 2017. GP education The Medical Director and the Consultant in Palliative Medicine for the Health and Care Trust have delivered three Palliative Medicine update sessions for GPs (as part of their local CPD programme), each session attended by more than 20 GPs, with positive evaluations and request for further sessions. Leadership and management The Institute of Leadership and Management level 5 training programme has now finished. Seven managers/supervisors completed the programme and one has requested an extension due to sick leave. This training was part-funded by the Worcestershire Local Enterprise Partnership (LEP). Registered Nurse Revalidation Registered Nurse Revalidation is now live and we continue to support Registered Nurses through the process. Staff and volunteer education and training days attended The 16th Annual Worcestershire Palliative Care Conference was held on the 14th July and 25 clinical staff from across the hospice attended. The conference this year addressed the theme of the increasing complexity and range of non-cancer cases that specialist palliative care now responds to. Effective conversations within a clinical setting, using a coaching approach A full days training was provided by a nurse coach from Derby Foundation Trust who routinely uses these skills in clinical practice to empower patients. This day was attended by all community nursing team members; useful clinical tools were introduced and practised within a safe environment. Mentor awards The In-patient Unit was awarded the Practice Learning Environment Award CCG/Independent Sector at the University of Worcester Mentorship awards. Mentor awards are an opportunity to recognise and celebrate the outstanding contributions mentors/practice educators/clinical supervisors and those responsible for learner assessment make to the success of students on courses across the Institute of Health and Society.

Nursing Times Awards The Care Director was nominated and shortlisted for the Nursing Times, Nurse Leader of the Year Award in October. The student nurse project, which the team have lead in conjunction with the University of Worcester and Worcestershire Acute Hospitals, was shortlisted for a student Nursing Times Award in the category ‘partnership of the year’. Team members from each partner organisation attended the Nursing Times Awards ceremony as finalists. Poster Presentations The education team presented a poster at the Royal College of Nursing, International Centenary Conference, December 2016 entitled passport to care. The team were approached at conference by the RCN Director of Nursing, Policy and Practice, to develop the ‘passport to care’ concept for wider nursing education. A proposal was submitted in December to the RCN Innovation in Education Forum, this proposal was successful and further development is now underway. Feedback from people who have attended education and training programmes One step beyond – A training programme for teachers supporting children with loss and grief: “I thought the style of learning and imparting of knowledge was outstanding. Very interactive and helped build confidence from other peoples’ experiences.” Medical student palliative care study day - “Good to see what a hospice is actually like, and to speak to a patient about their expectations and experiences.” University of Worcester student nurse placement experience – “All staff were keen to teach what they knew and all the staff were specialists in their field so had huge amounts of knowledge and experience to pass on. They were prepared for students with student packs and access to learning resources.” Three day End of Life Care programme for Registered Nurses - A project which enabled student nurses from all nursing branches to spend three days within the hospice. “We covered so much. I watched how as she empowered people and covered difficult subjects, while involving me the whole time. She valued my input which empowered me and built my confidence.”

CHAPLAINCY TEAM AND SPIRITUAL CARE The Chaplaincy Team provides support to in-patients, day patients, families, staff and volunteers. In addition, the team reach a wider population through the many funeral services and community events they conduct. The team has conducted relationship blessings, marriages, Holy Communion on wedding anniversaries, and a pre-wedding blessing for a couple before their legal marriage. The team is also involved in 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 recently died. The Chaplaincy Team was involved with 5 ‘Lights of Love’ remembrance services in November and December, contributing to an estimated number of 3000 people reached by

community events during the quarter. Events provide opportunities to renew acquaintances and to provide additional assistance as required and are appreciated by many people. Staff support also forms part of our work and this was provided both formally and informally throughout the year. The team provide spirituality and chaplaincy information to staff as part of their induction programmes and to medical students as part of their hospice clinical placement. A new quarterly initiative has been introduced; a service for Day Hospice staff and volunteers as an act of remembrance for patients who have died and the recognition of the relationships that are built, especially with those who attend for a long period of time. Another new initiative was to hold a quiet reflective time before Christmas, lighting candles and acknowledging the contribution made by every department at St Richard’s. Volunteers travelled from our shops and warehouse to join us on this occasion. The team also hosted Advent refreshments attended by staff and members of Men’s Space, with a quiz that provoked thought and discussion. Members of the team have been working on a Spirituality Course which will be offered on the Friday ‘Living Well’ days from June. This course will be entitled Spirituality: Finding inner peace and will explore spirituality using poetry, music, art and all of our five senses taste, smell, touch, sight and hearing. It is designed to be suitable for people of all faiths and those without any faith. Two longstanding Chaplain volunteers retired. A Buddhist Priest was welcomed to the team within this reporting period and is undertaking community visits as well as providing a useful resource. Patient and carer feedback “We would like to thank you for all your kindness and support during her final weeks at St Richard’s Hospice. We are so glad that you made sure the funeral service went smoothly and was such a great comfort to us. Thank you very much for your help.” (June 2016) “My reason for writing is to thank you. Thank you for letting me crash into your office whenever I needed to. To thank you for making the time for me to cry and to talk. The pressures of those final days felt unbearable but you helped me to bear them so that I could stay with my brother and support him right to the end. I thank you for your calmness, your stillness, for the prayers that we said together.” (September 2016) “You saw me at my worst but I hit rock bottom and I’ve learnt to bounce. I am proud that I stayed by my Grandma’s side. You were the start of my life changing forever and I’ll never forget.” (November 2016)

VOLUNTEER SERVICES Patient Services Volunteer Annual Report 1 April 2016 – 31 March 2017

Total 2017 Total Hours Total Value Chaplaincy Community Care Facilities Family Support Day Hospice In-patient Unit Therapies Transport Totals

1,289.31

£19,308.38

1,760.50

£14,059.38

5,818.57

£40,730.69

3,562.55

£45,353.42

8,733.23

£67,515.83

1,214.96

£8,504.72

1,015.46

£11,973.99

3,345.30

£23,431.40

26,739.88 £230,877.81

COMMUNITY ENGAGEMENT The Engagement Officer was a new role to St Richard’s and integral to the hospice’s ten year strategic plan to widen and deepen the knowledge of St Richard’s services to increase access, awareness and involvement in end of life care. The role engages with appropriate partners to build relationships and raise awareness of our care and support. Six priority areas have been identified to focus community engagement - rural communities, 55+ age group, men, health hot spots, Eastern European and Islamic community. Between June 2016 – 31st March 2017, 2000 people have been engaged with through role activity. Role activity includes working with patient participation groups to raise awareness in GP practices, building relationship with local mosques, representing hospice at health and wellbeing events and delivering awareness talks to appropriate audiences. The Engagement Officer has a work plan for 2017 to ensure priority areas are engaged with.

FUNDING OUR CARE Fundraising The fundraising environment continues to be challenging with income from both the general public and statutory sources reduced. Attracting voluntary income to sustain hospice contributions to the health and wellbeing of the individuals in the Worcestershire community is becoming increasingly vital. A further consideration is the plethora of new and emerging charities in the community all seeking donor support. During the next financial year St Richard’s has the challenge of raising more than £8.4million to fund the hospice services and plan for the future. We 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. 2017 - 20 promises to be very exciting for St Richard’s and includes significant building work to expand our services and widen access within the Worcestershire community. The hospice cannot do this without on-going support from the community and the involvement of many individuals, groups, clubs, schools, churches and local businesses. Trust and grant organisations remain committed to helping us, as do those that choose to leave St Richard’s a gift in their Will and this makes a huge difference to our work. We are indebted to everyone who supports us. Lottery At the end of the financial year Worcestershire Hospices Lottery has been able to distribute just over £92,000 to each of the three hospices; St Richard’s Hospice, Primrose Hospice and Acorns Hospice. Commercial Compared to the previous year trading is 0.5% down on turnover, however with an increase in expenditure due to the anticipation of opening shops in the north that have not yet opened our costs have risen, therefore our net profit contribution to the organisation was down 7.75% on the previous year. Nationally it is reported that an anticipated 12.5% decrease in net profit will be seen. We have worked hard this year on the infrastructure at the warehouse to support the planned expansion for 2017-18. Gift Aid still plays a huge part in increasing our net profit and the importance of signing up donors in our shops can make all the difference. We are currently averaging a 26% conversion rate which is generating £124,000 and if we increased that conversion rate to 32% it could bring in an extra £50,000 per annum. Our shop transactions this year were 607,783 compared to 620,560 last year. There has been a slight increase of £6,500 in our Gift Aid income. The £2.4m turnover of the Trading Company is only possible with the dedicated support of our shop managers and ancillary staff supported by our volunteers. The quality of the donations we get helps to contribute to the success of the department.

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

OUR CORE VALUES

GOVERNANCE STRUCTURE – 1ST JUNE 2017 Governors Senior Management Team Heads of Departments SRH Staff External

Hospice Services Committee

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

Care Quality Sub-Committee Professor T Thompson OBE (Chairman) Mrs J Cowpe Mrs V Gibson Miss C Gijselhart Mrs T Grint Mrs F Howarth Rev C Griffiths Mrs S P-Helm Ms S Wardell Head of Education Dr N Wilderspin ***** Mrs A Grout – Secretary

Council of Governors

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

Strategy Group

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

St Richard’s Hospice Trading Company

Mr A Glossop (Chairman) Mrs C Adams Mr D Corns Mr S Hyslop Mrs J Patel Mr J Woodcock ***** Mrs C Whitehouse Secretary

Information Governance Steering Committee Mrs J Patel (Chairman) Mr P Bahra Mrs T Cavell Mr D Corns Mrs L Clive Mr D Haigh Mrs L Preece Mrs D Scott Head of Education Mrs A Walford Dr N Wilderspin **** Mrs L Preece - Secretary

Finance & General Purposes Committee

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

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

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

Investment Committee

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

Health & Safety Committee

Mrs L Clive (Chairman) Miss S Arshad Mrs R Lewis Mrs T Cavell Mr D Corns Mrs V Gibson Miss C Gijselhart Mrs J Welch Mrs J Patel Mr K Radcliffe Head of Education Mrs A Walford

WHAT WORCESTERSHIRE CLINICAL COMMISSIONING GROUPS SAY ABOUT ST RICHARD’S HOSPICE The willingness to continuously improve care quality and patient experience is evident throughout all departments in the hospice. The values and beliefs of the organisation are clear and person focused leading to good outcomes for people who use the hospice services in relation to living well at the end of life. Commissioners commend the willingness of the hospice to work in partnership with other community services to deliver seamless pathways of care, the foundations they have built will stand the hospice in good stead as accountable care systems grow and develop in the county. The hospice continues to play a key role in the Palliative and End of Life Care Network in Worcestershire. We congratulate St Richard’s for continuing to innovate and improve patient care, despite the challenges posed from increasing demand and complexity of care required. Commissioners have always experienced a positive response to support required from the CCG to develop new pathways of care and we look forward to working with the hospice in the future to consolidate this work.

Debbie Westwood Head of Service Development NHS Redditch and Bromsgrove CCG | NHS South Worcestershire CCG | NHS Wyre Forest CCG

WHAT HEALTHWATCH WORCESTERSHIRE SAYS ABOUT ST RICHARD’S HOSPICE

Response to St Richard’s Hospice Quality Accounts 2016 June 2017 Healthwatch Worcestershire has a statutory role as the champion for those who use publicly funded health and care services in the county. This involves ensuring that the experiences and views of patients, carers and the public are used to influence how organisations, such as St Richard’s Hospice, provide services. We have used national Healthwatch England guidance to form the response below to the draft Quality Account 2016-2017 for St Richard’s Hospice.

Does the draft Quality Account reflect people’s real experiences as told to local Healthwatch by service users and their families and carers over the past year? •

Healthwatch Worcestershire has no evidence of any experiences or views on St Richard’s Hospice being recorded.

From what people have told local Healthwatch is there evidence that any of the basic things are not being done well by the provider? •

We have no evidence suggesting any of the basic things are not being done well by St Richard’s Hospice.

Is it clear from the draft Quality Account that there is a learning culture within the provider organisation that allows people’s real experiences to be captured and used to enable the provider to get better at what I does year on year? •

•

The Quality Account shows clearly that efforts are made to capture patient, carer and family feedback via feedback postcards and leaflets for the Hospice at Home, Inpatient Unit, Family Support Service, Day Hospice and Outpatient clinics, Occupational Therapy and Physiotherapy services. It is not clear from the Quality Account what is being done with the information recorded although future intentions are explained through workforce developments and membership of various regional and national bodies.

Are the priorities for improvement as set out in the draft Quality Account challenging enough to drive improvement and it is clear how improvement has been measured in the past and how it will be measured in the future? • • • •

•

The four priorities for improvement 2017-2018 are clearly laid out and challenging in light of necessary funding The size of the wide ranging projects will drive improvement It is noted that the Hospice achieved three out of the six priorities for improvement and partially completed the other three priorities set for 2015-2016 It is not clear what these improvements were measured against whilst acknowledging the work carried out with regional and national bodies which would require improvement measurement. It is noted that continuous evaluations of patient and carer satisfaction with services are completed throughout the year and that staff are encouraged to engage in audit activities as a form of evaluation. The work carried out as part of the Family Support Service to involve Year 10 pupils in visits to the Hospice to increase understanding of death, dying and bereavement within the younger generation is applauded.

St Richardâ€™s Hospice, Wildwood Drive, Worcester, WR5 2QT Tel: 01905 763963 Email: enquiries@strichards.org.uk

www.strichards.org.uk Registered charity number. 515668 Registered company no. 01850502