Three decades of compassionate Care Trinity Hospice Annual Review March 2014 - March 2015
16 week programme for day therapy patients One LIVE radio broadcast 12% of patients admitted to the in-patient unit had a non-cancer diagnosis 397 referrals to the Linden Centre s child bereavement services Community CNS team saw 1018 patients Open 24 hours a day 7/24 90 staff and volunteers have done Dementia Friends training 20,000 a DAY to run the Hospice 30 of compassionate care 22,000 meals served to patients 93% years 79% bed occupancy in the adult unit of staff say they are proud to work for Trinity 60% of our costs are covered by voluntary donations Almost 1000 volunteers Over 2000 event participants Pilot Hospice at Home reaching more patients Our retail sales pass 1 million!
Setting the scene One family s story Our first contact with Trinity Hospice was in November 2013, when Mum was referred to the palliative care of Dr Edwards. Our first visit could not have been more welcoming; tea was served in a reception area that you would not associate with a hospital, which the hospice is definitely not. Comfortable chairs, pictures on the walls and very spacious. Our appointment was on time and the attention we were given never wavered. Mum was referred to the Day Therapy Unit, and we went for a look round to see if she would like to go once a week. This was a definite yes, although she did think she would not be able to attempt any of the crafts. How wrong she was! Mum was picked up at 9.30am every Thursday and on arrival at the Day Unit, tea and toast was on tap. She made friends with others in similar situations - all they did was natter and laugh, there is no doom and gloom in there. A three course lunch is provided and tea and cakes followed. She was then taken home, tired but happy. Talk about being treated like royalty! Mum painted a lovely silk scarf, a tray and a plant pot. This time was invaluable for me, it gave me time to do other things, knowing that Mum was being cared for and enjoying herself. Whilst visiting the Day Unit I picked up a leaflet about the Linden Centre, which offers support to families and friends while their relatives are poorly or bereaved. The great thing is that you can self-refer; you don t go through your doctor. I was contacted the same day I submitted the request - amazing. The following week I went for an assessment and was offered counselling which I attended for almost three months. There is no timescale, each person is different and they will meet your needs. It really helped me come to terms with a previous loss and also helped prepare me for the inevitable loss of my Mum. Mum was admitted to the hospice in May 2014 and we could not believe how beautiful the unit is. The pictures of Blackpool are amazing, these things just help to make a very difficult time more bearable. The care and support the staff provide is fantastic, the atmosphere is relaxed, the nurses are proverbial angels, I cannot put into words how much I admire and thank them for the care they gave Mum over the month she was with them. Visiting is 24 hours and you are never in the way. Mum had her hair done in the new salon by her own hairdresser, flowers were allowed, food and snacks could be taken in if she fancied something different, she could go into the garden. The garden is beautiful and so calming. When Mum arrived the chef came to see her to let her know that if there was anything special she wanted to eat this was no trouble. In the reception area is a Memory Tree where I have had a leaf engraved with Mum s name; it is somewhere I can go and have some quiet time thinking of her and our life together. This may sound strange but Trinity Hospice is a happy place. How all the staff make this possible I don t really know, but I am forever in their debt for making my Mum s last month so comfortable and content. She was given the best care I could wish for words are not enough - thank you so much.
Enhancing the quality of everything we do It is with pride that we write this year as Chairman and Chief Executive of the 2014-15 Charity Times national award Charity of the Year. It s an honour which we believe reflects our commitment to providing excellent standards to the patients and families in our care and our drive for continuous improvement. Over the past year, and with the wonderful support provided locally in our Hospice Heroes campaign, we have transformed the patient experience through a major refurbishment to our In-patient Unit and in Brian House Children s Hospice. Our improved environment now provides greater privacy and enhanced dignity within a stunning high quality design. We have been praised by the Kings Fund as well as winning our category in the Charity Times award, which also focused on our Fit for the Future change programme. We are now better prepared for an increasingly unpredictable health environment with significant challenges and growing demand. The high point of my year It was the honour of receiving the prestigious Charity Times Charity of the Year Award on behalf of everyone at Trinity for amazing care, getting fit for the future and our ambitious refurbishment. David Houston CEO
Reaching more patients Our commitment to enhancing the quality of our care is as strong as ever. Over the past year, we have focused on improving discharge planning, holistic assessment and on the launch of a pilot Hospice at Home service with the help of our local Clinical Commissioning Groups. To date, it has been a great success and is supporting an additional 60-70 patients each week, many previously unknown to Trinity. It is also reaching a considerable number of patients with complex non-cancer palliative conditions who previously did not have access to hospice care this is a real step forward. We have made strides in providing timely and less onerous prescribing for patients by introducing non-medical prescribers in the community team and in Brian House. This also helps GPs who would otherwise have to prescribe directly on top of already heavy workloads. During the year, it has also been wonderful to see so many of the children in our care have further life enhancing experiences, not least through the introduction of a music therapist in Brian House a few budding pop stars are now among us! Our Schools Link programme, an addition to our front line counselling and bereavement services, gives help to young people on the Fylde Coast in many local schools through support to teaching staff. Earlier interventions make a real difference and enable more effective referrals to our Cascade children s counselling sessions at the Linden Centre. Commitment to quality Trinity Hospice is registered with the Care Quality Commission. In February 2014 the Commission carried out unannounced inspections and we met all the standards. Blackpool and Fylde & Wyre Clinical Commissioning Groups carried out a Quality Assurance visit in March 2015 which focused on: Respecting and involving people who use our services Consent to care and treatment Care and welfare of people who use our services Safeguarding service users from abuse Cleanliness and infection control Safety and suitability of premises Requirements relating to workers Staffing Assessing and monitoring the quality of our service provision Dealing with complaints. The Commissioners confirmed that the report has given them assurance that our services are at the appropriate standard. They say: The hospice has recently been completely refurbished, providing a well thought-out environment for patients and families. Patients are able to gain access to the lovely gardens from each bedroom and sitting room, even when completely bed-bound. It is clear that staff education, training and development are high on the agenda, as is patient feedback and a culture of continual quality improvement. The visit provided us with a very positive experience of a forward-thinking hospice, with high standards of patient and family-centred physical and psychological care and support. Financial turnaround The year saw our income remain resilient thanks to prudent management following our recent financial turnaround plan which removed a growing and unsustainable - 1.3m deficit. Strong legacy income helped, and general fundraising income grew just above inflation but we are budgeting for a deficit in 2015-16 and must grow our income at a faster rate to enable our services to grow and respond to ever increasing demand. We remain grateful to Blackpool, Fylde and Wyre CCG s who provide approximately one third of our 7.5 million annual running costs.
Our response to new challenges We believe our hard work has made a difference, however the Parliamentary Ombudsman s report Dying without Dignity highlights why we must do more, raise more funds and why we should fight our greatest enemy complacency. It describes cases of poor care compounded by little thought or dialogue with the patient and families. Thank goodness, more public bodies are speaking out to highlight how unacceptable such cases are, and how they contrast with the quality of care provided in hospices across the UK. How should we respond? It would be easy to look at what we do and say that we ve done our bit and lack the money to do more. But Dying without Dignity reminds us that such complacency would be a betrayal of the local people we serve and, like the rest of the health sector, we must continue to find new ways of working to unlock more time and resource. Technology, such as our new electronic patient record system EMIS, or the introduction of new models of care such as Hospice at Home and Associate Specialists are examples of the innovation which must become the norm. During 2015 we will fund an increase in our community and hospital teams as we work towards providing full seven day support. Our ability to care and our ability to fundraise are inextricably linked, of course, and in a competitive and closely scrutinised charity sector we need vision here too. Standing still is not an option, not least for the sake of those in the Ombudsman s report. Mary Wren-Hilton Chairman Standing still is not an option. David Houston Chief Executive Mary Wren Hilton, Chairman
Our clinical services During 2014/15, Trinity Hospice provided the following services: In-Patient Unit of 20 beds, offering 24 hour care for the most complex patients and their families. Clinical Nurse Specialists supporting patients and their primary care team in the community. Community Palliative Care Consultant supporting patients in Out Patient clinics and in their own homes. Clinical Nurse Specialists supporting patients and clinical colleagues within the Acute Trust. Day Therapy Unit offering patients a 16 week programme to build self-confidence and maximise quality of life during illness. Lymphoedema service for adults and children with primary and secondary conditions. Bereavement and counselling at our Linden Centre for both adults and children, individually or in groups. We also run a School Link Service, helping schools to better support children experiencing bereavement. Psychology support services. Complementary therapy, for both patients and carers, Physiotherapy and Occupational Therapy to support discharge, promote independence and improve quality of life. Social worker helping patients to stay in their own homes and supporting discharge planning from the In-Patient Unit. Spiritual care and support. Hospice at Home overnight service, seven nights per week, working in partnership with both Blackpool, and Fylde & Wyre Clinical Commissioning Groups, out of hours medical services, district nursing teams and ambulance service. Brian House Children s Hospice offering children, young people and their families respite and end of life care. Education, research and training. Quarterly bereavement services and annual remembrance events such as Light up a Life, Sunflower Day and children s Butterfly Service. Hospice Neighbours scheme, with trained volunteers supporting patients in the community by visiting them, taking them to the shops and appointments. To do all this we rely on the generosity of local supporters. Offering 24 hour care for the most complex patients and their familes.
Hospice at Home - a major step forward We developed and launched a two year pilot Hospice at Home service in partnership with Blackpool and Fylde & Wyre Clinical Commissioning Groups, having identified a gap in service provision. For many patients their greatest wish is to spend their final days at home with loved ones, and to avoid unnecessary admissions to hospital. The Hospice at Home service gives more patients the chance for this to happen. We launched across the whole of the Fylde Coast in September 2104. The service runs seven nights a week from 9pm to 8am. Two teams per night, consisting of a trained nurse supported by a healthcare assistant, respond to scheduled work, but mainly to unscheduled requests for help and support. Use of the community care plan held by patients avoids the extra work of a separate referral form, ensuring effective use and timeliness of the service. Our aim is to support more end of life patients who would not necessarily be helped by the specialist team at Trinity, and for more patients to achieve their choice of dying at home, avoiding inappropriate hospital admissions. The number of patients supported in the first 10 months is 593, and of these, 263 patients were not previously known to Trinity Hospice. There has been excellent feedback from patients and families. Investing in our staff A number of staff in the Clinical Nurse Specialist team and Brian House completed the Non-Medical Prescribing module. Nurses now qualified as nonmedical prescribers are able to prescribe for patients in a more timely way, so enhancing care. Trinity has seen an increase in the number of requests from patients and families and professionals seeking advice, so telephone triage training was undertaken by 16 staff to enhance our over the phone advice service. A total of 90 staff and volunteers have done the Dementia Friends training and 66 have completed the Let s Respect Dementia course. The high point of my year Achieving 30 years here at the hospice. When I started in 1985 I would not have believed that I would have achieved the position I am in. I remain passionate about ensuring patients and their families receive the best care, proud to have been part of Trinity and fortunate to have had a very fulfilled working life. Julie Huttley, Clinical Director. Our ambitious refurbishment has given us much enhanced environments for adult In-Patients and at Brian House.
Our medical team We made significant progress on prescribing, with nonmedical prescribing by nurses transforming the work of the CNS team in the community and at the hospital, enabling a more rapid response to patient needs. We will continue to roll out the programme more widely. In addition, we introduced a new comprehensive prescribing booklet, which has helped the accuracy and safety of prescribing across the In-patient Unit at Trinity. End of life and dying with dignity issues have continued to make national headlines, and an individualised end of life care plan was successfully rolled out across the Fylde Coast, led by staff in the hospice. It includes a communication booklet for use by relatives when they need to write down questions or comments around the care of their loved one. Our Medical Director Dr Susan Salt was appointed Chair of the Palliative and End of life Care advisory group for Lancashire and South Cumbria with a remit to enable high quality care across the area. We reorganised medical on call at the hospice as a step forward in moving the service towards seven day a week face to face medical assessment of patients when needed. Our joint working with non-cancer specialists, particularly around heart failure, respiratory failure and Motor Neurone Disease has led to a significant increase in the number of patients with a non-cancer diagnosis who are approaching the end of their life being cared for by Trinity. Our Day Therapy Unit s 16 week programme has led to a significant increase in the number of patients being seen, attending and completing the programme and there has been good feedback from patients and families. Looking ahead, we are working hard to move to an online patient records system, which should help in our joined up approach across services, both at Trinity and in the wider health care sector. The high point of my year Two things: training for and running the London Marathon, raising almost 5000 for the hospice, and being appointed Chair of the Palliative and End of Life Care advisory group for Lancashire and South Cumbria. Dr Susan Salt, Medical Director.
During the past year: In-Patient Unit 366 patients were admitted Average length of stay 14.8 days 74% of patients died in their preferred place 12% of patients had a non-cancer diagnosis Day Therapy Unit 143 patients accessed the Day Therapy Unit 34% of patients had a non-cancer diagnosis Community CNS team Total number of patients seen 1018 Average length of stay in the service was 54 days 13% of patients referred to the service had a non cancer diagnosis 87.5% patients who were known to the team died in their preferred place 88.4% died outside of hospital Hospital team Total number of patients referred was 806 29% of patients had a non cancer diagnosis Average length stay in the service was 7.5 days 66% of patients known to the service were discharged from hospital Of the 806 patients referred to the service, only 101 died in hospital Lymphoedema service Average number of patients accessing the service was 507 There were 276 new referrals Linden Centre Referrals to our adult bereavement service: 341 Referrals to the childrens bereavement services: 397 Brian House Children s Hospice Total attendees 652 Butterfly Suite used for 45 days
Fundraising The biggest challenge in fundraising is to keep income up to speed with the rise in costs which an increased demand for our service inevitably brings. With the UK emerging from recession and with the charity sector s fundraising methods under intense media scrutiny in Spring 2015, our fundraisers have worked hard to develop new and more engaging events and opportunities to donate, always remembering that community support is our most valuable resource. Relationships with local business partners led once again to a very successful Corporate Challenge; the Capital Appeal came to an end having generated almost 300,000 in partnership with the Blackpool Gazette, and our prize draws proved to be a very successful funding stream. Local businesses such as Beaverbrooks were once again valuable sponsors. New events Individual sponsorship raised by event participants has fallen, even where actual participation rates have held firm, but Trinity s 30th birthday was the perfect opportunity to introduce some new events to the calendar, and in March a Dinner with Swing for Brian House was held in St Annes, with a Colour Splash run and special anniversary mailing ask planned for summer 2015. We were proud to be chosen as official partner charity for the Lytham Festival eight days of music and culture on the Fylde Coast - and agreed to provide 170 volunteers in exchange for a donation and the opportunity to fundraise at each Festival event in August 2015. There is also potential to develop both regular giving and community fundraising. A canvassing campaign to recruit more Lottery players has been very successful and there are now over 4,500 weekly players. Legacy income was excellent, but looking ahead we must find ways to mitigate the expected fall in the coming year.
Raising our profile Visits to our website continue to increase, and a particular focus on social media has given us a new window on the world and an opportunity for instant communication. We amassed over 300 press cuttings. We launched a new website for our medical and clinical teams and allied healthcare professionals to use as a repository of good practise in palliative care. We also played a lead role in organising and promoting events such as Dying Matters and Hospice Awareness Week, which are opportunities to reach new audiences and spread important messages about hospice care. Our retail team Our retail department had a mixed year, with overall net profit decreasing by 4% and profitability per shop decreasing from 22k in 2013/14 to 19k. However during the last quarter of the year, following a restructure of management, we began to see an upturn. Major milestones include securing a new hub to combine retail and warehouse space in Blackpool (scheduled for opening autumn 2015); a move into online trading on platforms such as ebay; Gift Aid training and customer service training for our shop managers to maximise donations and profit and improve customer experience; stock generation initiatives to increase sales and encourage partnership working with local corporate supporters. Our shop income increased by 12%, from 964k to 1,077k, (including sales on which Gift Aid of 141k was claimed). The increase in revenue is mainly from our Lytham shop, which opened in May 2014, but average revenue per shop increased by 4% from 69k to 72k. We have a team of 220 retail volunteers to help in encouraging donations of stock, increasing sales and promoting volunteering and our continued integration of Retail with Fundraising, Facilities and Finance has brought a more joined up approach. Our retail plans include opening one new shop a year in places where we do not have a presence and re-negotiating existing leases to ensure we trade on the most favourable terms.
We have a team of 220 retail volunteers to help in encouraging donations of stock, increasing sales and promoting volunteering. People who make a difference Just a few examples of who helps us and how Merlin Entertainment bought Brian House a brand new mini bus so that for the first time groups of our children can travel together in style. Their first day out was May 2014. Event promoters Cuffe and Taylor donated 1 from every ticket sold for its Rod Stewart concert in 2014, adding up to 25,000 in a cheque handed to us by the man himself! Local craftsmen joined forces to supply and fit a new kitchen and dining area in our family apartment at Brian House: a top quality job from a top quality team! An anonymous supporter once again sponsored our glittering 2014 Fundraising Ball, so that the 40,000 raised on the night could go towards patient care. Our staff and volunteers took part in some imaginative in-hospice fundraising events: from buckets of water to bake-offs. Supporters gave an amazing 70,000 bags of items to our shops. An average bag is worth about 15 and donations like this keep our shops open. Our Friends Groups remained very active in the community (and together should break the 1 million fundraising mark in summer 2015). The cast of the Grand s Christmas Panto came and entertained Day Unit patients. And two little girls who had too many choccy eggs arrived at our reception desk on Good Friday to donate them to the children in Brian House.
Our people Our staff have continued to provide the highest standards of care to patients and their families over the past year. In doing so they have demonstrated a huge committment to the demand for training and development as the skills required to care for more complex patients increases. 20014/15 was the first opportunity to conduct the annual staff survey following the Fit for the Future programme and the results provided by our staff were excellent with increased satisfaction scores in every area covered by the survey. A successful Leadership and Management programme was developed and delivered over a 12 month period and attended by the Trinity management team. The programme covered all aspects of leadership skills and techniques and the positive outcomes of this have no doubt also been reflected in the results of the staff survey. The workforce has continued to remain stable in relation to attrition and sickness absence levels and therefore more time has been invested in providing training and development above and beyond the mandatory training programme. New initiatives have been launched to enhance the staff benefits that Trinity is able to offer, which will assist in both retaining our current staff and also attracting new employees when recruiting. The initiatives include a salary sacrifice scheme which offers the opportunity to buy bicycles, home technology equipment and cars at competitive rates and repayment methods. In 2015/16 we will extend the salary sacrifice scheme to our pension scheme and will continue to look for more opportunities to develop our staff benefits. Although the financial climate in the charity sector remains challenging the Trustees agreed that it was the right time to reward all staff and a 1.5% pay increase was awarded in April 2014 and a further 1.5% pay award with effect 1st April 2015 was agreed, in order that Trinity remains competitive as an employer of choice. In our 2014 staff survey: 93% of people say they are proud to work for Trinity 95% say they enjoy the work they do 90% say they feel they are making a difference
The high point of my year Being asked by a patient if I would sit with them whilst they shared with me their favourite poem. This experience reminded me that our clinical staff are not only highly skilled but also give this kind of compassionate care 24 hours a day 365 days a year to our patients and their families, which makes me very proud. David Warburton, HR Manager. Volunteering Trinity continues to be very well supported by a large team of loyal and committed volunteers. As we celebrate our 30th anniversary of care it was wonderful to present five of our volunteers with a 30 year long service award. At the start of 2015 a Retail Campaign was launched to increase the number of volunteers supporting our 15 shops. This was very successful, with 45 new retail volunteers in place by the summer! We launched a pilot Hospice Neighbours scheme. Existing volunteers were recruited and trained initially to become companions to patients in their home following discharge from our Day Therapy Unit. This was well received, with patients appreciating the continued connection to the Hospice through their Hospice Neighbour, enjoying trips out to bingo or shopping, or just enjoying a cup of tea and some company. We are hoping to grow the service and have opened the scheme to new volunteers and to any patient accessing Trinity s services. Following our nomination, one of our long standing volunteer drivers was chosen as a Community Champion and invited to attend 10 Downing Street and the Houses of Parliament as a thank you from the Government for all he has done in the community. 2015 sees five of our volunteers celebrate 30 years of service to Trinity. What an incredible achievement. Add up the length of service of ALL our current volunteers and it s over 600 years!
Focus on our costs Trinity continues to make progress towards long-term financial sustainability and the result for the year was a surplus of 1,271,454, from a surplus of 2,287,423 in the year to 31 March 2014. That difference is mainly accounted for by an accounting transaction in 2014 releasing 994,850 originally received in 2006 but which was held on the Balance Sheet as deferred income; No similar transaction was made in 2015 but we did experience a second year of exceptional legacy income; one in every four patients we see is cared for by this vital source of funds. Sadly the current year shows a sharp decline in legacies. Our surplus does not take into account our capital expenditure, which was just over 500,000 in the year; most of it relating to our refurbishments. Purchasing power We continue to focus on our costs, to ensure that everything we procure gives us the best value for money. We helped form the innovative Hospice Quality Partnership (HQP), an organisation set up by 25 hospices to use their collective 1bn purchasing power to secure significant discounts in the main products we buy. We hope that savings from HQP will be seen in the coming year. We have been within budget for expenditure across the Hospice as a whole for the third year running, helped by regular communication between our finance department and our managers across the Hospice. Our clinical managers now work more closely with our fundraising department to identify in advance items that we may be able to secure grants for. But we cannot be complacent. Our 2015/16 budget shows us going back into deficit due to a reduction to normal levels of legacy income and an increased demand for our services. Even taking care to spend each pound wisely, the Hospice costs 20,000 a day to run. For example: Our annual gas and electricity bills are around 50,000 each. To maintain our buildings costs around 200,000 a year We spend around 100,000 a year on medical equipment and supplies. The high point of the year It has to be the support I received from the organisation whilst being treated for cancer. I continued to work throughout, but that was my choice to do so and Trinity, the organisation and all the staff have been fantastic throughout. Helena Lavin, Finance Director
Income 8,806,362 Donations (including Friends Groups*) 1,503,327 Legacies 2,274,230 Shops 895,148 Lottery 255,655 NHS (PCT) 2,452,590 Other funding and income 928,079 Investment income 302,079 Department of Health 195,254 * Gift Aid income of 141,000 from our shops is also included Expenditure 7,534,908 Adult In-patient Unit 2,658,098 Day Therapy Unit 223,348 Brian House 1,203,984 Lymphoedema 172,068 Linden Centre 282,241 Learning and Research 138,063 Clinical Nurse Specialist team 921,738 Hospice at Home 240,926 Fundraising staff, support staff and establishment costs 588,079 Trading costs including Lottery 965,152 Investment management costs 68,611 Governance costs 72,600
Listening and learning Getting feedback from our users has always been important at Trinity; it helps us know what we are doing well, and where we could improve. It also generates some really good ideas. One of our 2014-15 targets was to find a better way of collecting and collating feedback across all our services, and in April 2015 we signed up to iwantgreatcare. It s still early days, but here s a flavour of what our patients and their families are saying Had total trust in the staff that looked after my mum. The Hospice at Home staff were an emergency lifeline to myself and my dad when my mum was gravely ill at home. They visited and provided advice, All aspects of my care and treatment have been given with respect and consideration for myself. guidance and expertise whilst being very warm, caring and providers of great hugs! All the staff show compassion and give excellent support and advice. Each time I leave my child at Brian House I leave feeling very confident my I had bereavement counselling which I found invaluable to my state of mind and situation at a time where I found myself lost, anxious and in a very strange place. daughter is being cared for at a high standard. See www.iwantgreatcare.org
We re looking forward to... Electronic patient record keeping helping co-ordinate more timely support across services Improvements at the Hospice - a more modern main reception area and additional garden facilities New events as part of our 30th birthday and a staff and volunteer celebration! Solar panels and even better eco-awareness Collecting more patient and family feedback online through iwantgreatcare Launching and living a new set of Trinity Values, which underpin everything we do Our Hospice at Home pilot becoming a permanent service Providing additional community and hospital CNS nurses Seven day access to all In-patient and community services Opening a new retail hub in a town centre location Building new relationships across health, education and business sectors across the Fylde Coast
Do the Santa Dash Run the 10K 6 Take the Corporate Challenge Join the LOTTERY Buy a leaf on our memory tree Host a Buy a raffle ticket Do the Bike Ride Donate goods to our shops Light up a Life Donate a prize Low Moor Road, Bispham, Blackpool FY2 0BG Tel: 01253 358881 www.trinityhospice.co.uk Sunflower Memories Day Registered charity no. 511009