The Service. St Margaret s Hospice, Somerset

Transcription

1 St Margaret s Hospice, Somerset The Service Please describe the 24/7service including: Where services are provided e.g. home, community, hospice, hospital? Do you offer the following: 9-5 Sat face to face assessment /admission 9-5 Sat and Sunday face to face assessment/admission Weekdays till 10pm 24/7 face to face assessment/admission (including week nights and weekends) 24/7 telephone advice (including week nights and weekends) Population of 520,000 supported by St Margaret s Hospice. One hospice organisation supporting 2 hospice inpatient units with 12 beds in each unit. 7 day week admissions, including evenings if appropriate. (Palliative care services for part of the north east population of Somerset is provided by Dorothy House Hospice). Criteria based on specialist palliative care needs, regardless of prognosis, disease state. 24/7 across county (whole of Somerset) telephone advice and support to health care professionals, patients, families, including those not known to the hospice and linking with NHS 111. Palliative medicine consultant on call for advice 24/7. The team are looking to extend access to the service through other methods e.g. use of telemedicine. In Patients Unit - Saturday and Sunday face to face inpatient ward round each morning and admissions if required for clinical need, at weekends. First and second medical on call Community 5 locality teams, linked to specific General Practitioner practices, with Community Nurse Specialist (CNS) and Registered Nurses (RN s) within the teams. There are 3 non-medical prescribers within the community CNS teams. Limited face to face visiting service from hospice nurses and MDT assistants at weekends in the community. Planned and responsive phone calls to patients and families in community over weekend. Hospital palliative care services link with but are not provided by the hospice. The hospital sites are able to call the advice line 24/7

2 Is the service for the public, patients and families or just for health professionals? If patients are included is it for all patients or just those known to your service? How is the service accessed by public, patient, carer or professional and who can refer into the service? E.g. does this include self referral? A person does not have to be known to the hospice service to gain advice. The advice line is available for public, patients and families as well as professionals 24/7 365 days. All hospice services allow self-referral, but there are only a small number of self-referrals. Calls are also received from people recently diagnosed asking for advice and information. The single point of access number is well advertised on the website and through cards given to patients and public in areas such as outpatients/public information booths. How do you ensure equality and equity in service provision? i.e. that hard to reach groups and communities access the service and equal provision is provided across the whole population or those with a non cancer diagnosis. Is the service specifically marketed on your web site as a 24/7 advice/emergency service? Information regarding 24/7 advice and support on posters and on cards available in General Practitioners surgeries and hospitals; Education and awareness raising sessions have taken place with homeless charity workers, gypsy and travelling community workers and advice line information given; Non cancer specialities including joint heart failure study days and close links with neurology nurse specialist and respiratory services. Hospice staff attend Hospital palliative care Multi-Disciplinary Team meetings. Dementia lead identified with ongoing training and dementia friendly ward development. Details of advice line are on the front page of the hospice website, it is not advertised as an emergency service; There is one clinical commissioning group (CCG) for Somerset. The service works closely with this group to align our aims for high quality end of life care. Having one CCG helps to support equality in service delivery across the population. Do you involve patients, their carers or those important to them involved in the planning of their treatment? If so, please describe how this is achieved? Outcome Assessment and Complexity Collaborative (OACC) measures now used across all services including inpatient, community and day hospice services with growing confidence. A goal centred rehabilitative approach to care is led by the patient and MDT where appropriate in inpatient and day hospice areas. This is achieved through shared decision making.

3 On-going training is provided with staff in the use of OACC. The service has found that the benefits of using OACC include using a consistent approach to identifying patient need and phase of illness. It also helps the service to focus on the actual needs identified by the patient, not making assumptions about these. How is the service staffed? e.g. doctors, nurses, therapists. Does the service provide integration between health, social care and the voluntary sector? Does the service integrate with local initiatives regarding urgent and emergency care? Full MDT: Consultants, specialty Doctors, General Practitioner trainees on rotation, CNSs, RNs, Physiotherapists, Occupational Therapists, Social Workers, Spiritual Care Team, Complementary therapists, psychotherapeutic lead, family support and bereavement team, lymphoedema team, MDT assistants, Healthcare Assistants, Assistant practitioners, student nurses. Occupational Therapists and Social workers are joint funded between the hospice and Adult Social Care: In Patients Unit (total staffing for 2 Inpatient Units) o Lead Nurse WTE o Senior RN WTE o RN WTE o HCA WTE o Assistant Practitioner WTE o Hospice Consultant WTE o Specialty Doctor WTE supported by GP trainees and Specialist Registrars on rotation Community (supporting 5 community teams and 24hr advice line) o Lead Nurse WTE o Community Nurse Specialists WTE o Registered Nurses WTE o MDTA/ Healthcare Assistants WTE o Assistant Practitioner WTE Day Hospice (2 sites each operating over 3 days/ week): o Lead WTE o Healthcare Assistants WTE o Diversional Therapist WTE o Volunteers Physiotherapy: o Physiotherapists including leads 3.0 WTE o Physiotherapy assistant WTE o Social Workers WTE

4 o Occupational Therapists WTE Lymphoedema: o Specialists including Lead WTE o Key workers WTE o Healthcare Assistants WTE Supportive Care: o Psychotherapeutic Lead WTE o Spiritual Care WTE plus volunteer team o Family Support worker WTE plus volunteer o Bereavement Support Coordinator WTE plus volunteer team o Complementary Therapy Coordinator WTE plus volunteer teams A multi-disciplinary approach with electronic patient records, helps to improve patient care and ensure that action plans are in place. The approach taken, including using OACC as a tool, helps to improve communications regarding patient care and cuts down the number of visits required through crisis avoidance. Palliative medicine consultants work as a consortium and are employed by Somerset Partnership NHS Foundation Trust and work across the community (GPs, DNs, community hospitals and with community CNSs), acute hospital trusts and the hospice, in-reaching into each service. One additional palliative medicine consultant is employed by and works directly with the hospice, but is an active part of the wider consultant consortium. Clinical strategic meetings are held with the consortium and hospice. As mentioned, the social workers and OT s within the team are 50/50 jointly funded by health (St Margaret s Hospice) and social care. Having social workers and OTs within the team enable us to support all of the patients needs providing a proactive not reactive service and to work across health and social care. Volunteers working across most services and also include volunteer befriending service and support groups. These volunteers receive corporate induction training and additional, bespoke training according to the service which they will be working within e.g. for those working within the befriending service they will attend a four day training course. Volunteers receive supervision support. The service is planning to extend the range of services and support provided by volunteers. CCG meetings have hospice membership and representation e.g. OOH and Urgent Care clinical assurance group

5 Implementation Who funds the service? e.g. NHS / charitable sector. If it is funded jointly, what is the percentage of funding from each sector? Can you please share the local contractual arrangements? How much does the service cost per annum? 24% of direct clinical costs are supported by NHS funding (equating to on to around 1.8m of the total cost), the remaining costs need to be raised by the charity. Only the lymphoedema service is fully commissioned by the CCG. Quarterly contract review meetings take place with the CCG to review activity and quality performance. Joint funding is in place between Adult Social Care and the hospice for the total costs of the Social worker and Occupational therapist roles. The contracts are with ASC and the work base is the hospice. Joint contract meetings take place on a 6 monthly basis with contract renewal on an annual basis at present. Total clinical costs for all of the hospice services : 7.5 million per annum Can you please describe the organisational and governance arrangements that are in place to deliver the service? e.g. what follow up arrangements are there if calls are taken in the out of hours period? St Margaret s has a Director of Governance who supports governance across the whole organisation. All advice line and referral calls are recorded. All staff working on the out of hours advice line have completed training and competences. The single point of access number is manned one a 1:1 basis by a palliative care nurse from 8am to 12 midnight each day. Between midnight and 8am, calls to the number are taken by the ward night staff. All information is recorded on the electronic patient notes system in real time. When a call is received relating to a patient known to the hospice, OOHs advice is given or NHS 111 will be contacted if further support is required. If a patient is not known, a referral may be taken, a cross care number generated and immediate support and advice given if they are known to another hospice in the area, that hospice will be contacted to let them know that one of their patients has called and the nature of the call. A system is in place to notify the community team that the patient is known to, so that it can be followed up in hours.

6 Quality checking of recorded calls takes place by a senior clinician. Staff are encouraged to report any concerns that they have regarding Out Of Hours calls taken. A palliative medicine consultant is on call and available each day for the advice line staff if required and will provide the member of staff with support or speak directly to the caller, either patient, carer or health professional. The telephony system monitors all calls including any calls not answered. A record of calls from district nurses was kept, with the reasons for their calls, to share with the DN leads to help identify further palliative care training needs. Are there any considerations required when implementing this service e.g. IT requirements? Additional training requirements? Consent to sharing patient information? Is there a local Electronic Palliative Care Coordination System (EPaCCS) in place? IT needs: The hospice runs the crosscare system for notes keeping. This is a full EPR solution which can be updated and interrogated by the hospice for quality assurance and governance needs. Via completion of the NHS information governance toolkit standards it is hoped the hospice can join regional work on interoperability to offer information from the hospice system to other relevant parties (with appropriate consent from individual) Training requirements: Internal staff: Staff are trained in call handling in addition to their clinical expertise in palliative care External staff and public: Having a single number for all services is helpful to maintain a simple and visible message of calling the hospice then discussing how the hospice can help. Consent to sharing information: this is undertaken by a referrer to make the referral then any additional consent for EPACCS use etc is made and recorded by the hospice. EPaCCS: local system Adastra in place, accessible by Primary and secondary care, third sector providers (hospice), OOH medical and ambulance services. Not currently national information standard compliant.

7 Outcomes How long has this service been running? Could you please provide an approximate breakdown of the total number of patients supported showing separately, if possible, those in the out of hours period either by phone or face to face during per year? What other quantitative performance measures are used to measure success? What qualitative performance measures are used to measure success? Hospice services have been running for 36 years. The 24 hour advice line service has been operating for 5 years. The services as a whole support 3200 patients across all inpatient, community and outpatient services annually (including lymphoedema services). The out of hours advice line supported around 5500 calls equating to 3100 episodes in 2015/16. The line was used for 1329 individual patients There are set activity targets by the CCG and for other services the service sets their targets. The service exceed all referral targets set. This can be seen as both a measure of success and raises sustainability concerns. The service review trends in relation to activity and who is using the services, adapting service models as required. There are response times for referrals to all services which are monitored and reviewed if not being met. Iwantgreatcare which incorporates the friends and family test is encouraged across all services. National benchmarking in relation to falls, pressure ulcers and medical incidents and bed occupancy, with reporting to Trustee Board against all of the above. Are you able to share any patient or relative testimonials or feedback regarding the service?..i can never express how reassuring it was to know I could call you whenever I wasn t sure about something, needed advice or was just a bit scared. Everyone who answered the phone, every nurse I spoke to, OTs were amazing and I cannot praise everyone enough. XX especially, thank you from the bottom of my heart for stepping in when you did and helping keep XX at home with his family... I'm so grateful he passed away peacefully at home and

8 not in the hospital. To have you helping and supporting us through a painful, heartbreaking time was a real comfort... My sister was a patient with you for six days. Nothing was too much trouble she was looked after with such great care and attention. We as a family and her partner were also given every thing we needed. The Sunflower suite was made available for our use which meant we could stay close by. I have always been a little scared of the word hospice, but after our experience with you that is no longer the case. It was terrible to lose my sister but to be able to watch her being so well cared for at the end really helped a huge amount, Special thanks to XX for organising the blessing service and the flower volunteer for the lovely posy she made. For further information please contact: Joy Milliken Clinical Director Joy.milliken@st-margarets-hospice.org.uk Telephone Number: