Quality account 2015 2016

Chief Executive’s statement

“This has been a year of consolidation for the Charity. We have protected our core in-patient beds as far as possible within the funding available and on a sustainable basis for the immediate future. We have engaged with both hospital and community services to encourage greater collaboration and closer working. We have a much improved relationship with our Commissioners but remain concerned at their low level of contribution to our vital services.This seems unlikely to improvein the light of the current funding crisis in Cornwall’s healthcare community.

The Board have comprehensive clinical management and assurance structures in place to satisfy themselves about the quality of care provided both within the two hospices and in the other settings that we actively support. These structures include the Clinical Governance and Clinical Services Committees as well as ongoing scrutiny by the full Board of Trustees on a quarterly basis. Trustees continue to make Provider Visits to both in-patient units to assure themselves that the Care Quality Commission’s Standards of Care are being met.”

Paul Brinsley Chief Executive

Cornwall Hospice Care: Quality Account 2015/2016 2

Statement of Assurance from the Board of Trustees

“On behalf of The Board of Trustees, I would like to put on record our appreciation of the hard work and commitment of all our staff and volunteers over the past year. The Charity continued to face both financial challenges and a very uncertain commissioning environment, which gave us all much cause for concern.

Nonetheless, thanks to the efforts of our staff and the generosity of all who support us we have come through the year in better financial shape. Our income generation teams have been highly effective in


improving performance on the previous year and are to be congratulated on their success.

This will undoubtedly help us to face with greater confidence the continuing uncertainty around commissioning intentions and the NHS’s commitment to end of life services.

Over the year we have provided a very high standard of care to patients facing terminal illness and to their families. Our ethos around providing clinical and supportive care continues to be one of quality, service and compassion. Clinical excellence is a key factor in delivering that care and we continue to invest in our staff to ensure they have the skills necessary to keep them at the forefront of specialist palliative care. To the best of my knowledge, the information reported in this Quality Account is an accurate and fair representation of the quality of healthcare services that we provide.”

Lesley RossChair of Trustees

Who we are and what we do The Aims

Cornwall Hospice Care is a registered charity committed to providing Specialist Palliative Care (SPC) and End of Life Care (EoLC) for complex patients, irrespective of diagnosis, over the age of 18 years. Our care delivery is in line with national guidelines.

We aim to provide an expert, flexible and responsive service which works cooperatively with other health and social care providers to support patients wherever they are in Cornwall. The care we provide is available 24 hours a day, 7 days a week, we are there when people need us. Our highly trained teams are experts in their field and provide the care totally free of charge. We provide support to both in and out patients, working at the charity’s two hospices, in Cornwall’s hospitals, nursing homes and where appropriate, in people’s own homes.

We also run a 24 hour advice line for other healthcare professionals who need information and support when caring for those with life limiting illnesses.


Cornwall Hospice Care Healthcare Assistants Sara and Sandie


We have two inpatient units, at St Julia’s Hospice in Hayle and Mount Edgcumbe Hospice in St Austell, providing 16 inpatient beds across Cornwall. Patients are referred by any of their key health professionals, but always in liaison with their GP or Hospital Consultant so that we can ensure continuity and coordination of care. Most patients come into our units because they are having a difficult time with symptoms or the impact of their illness. They will be assessed by our multidisciplinary team and a plan will be discussed and agreed with them and whoever, family or friends, they wish to be involved. This will be reviewed regularly throughout their stay.

Our expert and experienced nursing teams care for and support patients and their families throughout their stay and maintain a high level of skills to deal with the increasingly complex medical problems of our patients. Both units have daily consultant input supporting a team of experienced speciality doctors and specialist and general practice trainees. Medical and consultant on-call cover is provided by our own doctors 24/7. There is a full multidisciplinary team of allied healthcare professionals in occupational and physiotherapy, psychological support and lymphoedema working within the units. We also work closely with other specialist teams such as speech and language therapists, dieticians and specialist nurses who visit the units as needed. This ensures that patients can have the specialist care they need whilst minimising unnecessary trips to hospital. Our average length of stay is twelve days, with a range of a few hours to several weeks, dependent upon patient need. We aim to discharge patients home or to an appropriate place of ongoing care, with the right support, once their acute symptoms and problems are stable. Many patients come in on more than one occasion over months or years during their illness.

Inpatient care

“If I won a million pounds and gave it to the hospice it still wouldn’t pay for the loving care given by everybody.”

Outreach and Outpatient Services

We provide a 24 /7 specialist advice service for healthcare teams throughout Cornwall to support the care of patients, wherever they are. If a patient needs specialist review and is unable to be moved or travel, we can provide a consultant review at home, in a community hospital or care home at the request of the GP and community team.

We have a specialised team of allied health professionals who will all see inpatients and offer outpatient appointments. Patients attending for outpatient reviews have the opportunity to see a number of expert professionals in a single appointment, at both hospice sites. This may include review by the specialist Lymphoedema nurses, physiotherapist, occupational therapist and complementary therapist. Our occupational therapists and sometimes our physiotherapists also review patients at home when needed.

We provide consultant support to the community palliative care nursing teams via their weekly multidisciplinary meetings across the county. This will involve discussion of patients with difficult symptom control issues and may result in advice to the specialist nurse supporting that patient or the option of an outpatient visit or domiciliary visit with the specialist nurse or GP.

We work closely together with the palliative care team at the Royal Cornwall Hospitals, and provide consultant review in clinics or on the wards as requested. We also review patients and advise on care in all the community hospitals throughout Cornwall. This means that patients can have a specialist palliative care review in any of the hospitals in Cornwall by a specialist nurse or a consultant, according to their needs.

Our consultants can also see patients as outpatients at the hospice units by referral from GPs or Hospital Consultants.


“Thank you so much for your care and attention over the last few days. I feel like a new person!! What you do is amazing, keep up the good work!”

Heather Basher, Hospice Volunteer, Cornwall Hospice Care

We have a well-established pain and palliative care service which enables patients with complex pain and palliative care needs to be assessed promptly in a joint clinic and have access to the most appropriate treatment, whether that is medication, interventional treatment such as nerve blocks, or physiotherapy and support.

Our consultants work with the oncology teams at the Royal Cornwall Hospital to provide joint clinics in the Sunrise oncology centre. These enable patients’ symptom and support issues to be addressed alongside their cancer treatments to ensure the best possible care at all stages of their illness.


Safety of patients is of the utmost importance to all staff at Cornwall Hospice Care. The collection of quantitative and qualitative data, audit, benchmarking with other hospices in the southwest, case presentation and peer review builds into a rich resource of information about the treatments we offer and the work we do with patients.

This informs practice development and ensures that as an organisation we are utilising the most effective and up to date methods and equipment.

Cornwall Hospice Care has reviewed all policies and governance arrangements in the last year. There is a robust structure which reaches from the grass roots clinicians to the Trustees at Board level. Terms of reference and work priorities of the Clinical Governance Committee have been reviewed and a new Quality Assurance Committee has been established to strengthen areas such as audit outcomes and learning and medicines management.


Michelle Earle, Therapy Manager, Cornwall Hospice Care

“I would like to most sincerely thank you, staff and volunteers, who looked after us with loving care. There could have been no better care than your team provided.”


As an organisation we are committed to delivering the best possible experience of care and outcomes to all our patients and their carers. We have been collecting patient recorded outcome measures (PROM) for several years, using a validated questionnaire exploring symptoms and quality of life. (St Christopher’s Hospice SKIPP tool).

The data from 185 consecutive hospice admissions was collected and analysed by medical students in 2014/15.

During the year all the data has been analysed and this has resulted in poster presentations both locally in the University of Exeter Medical School and internationally at the European Association for Palliative Care Conference in Copenhagen in 2015.

The hospice is a major contributor to clinical placements, teaching and supervision at the University of Exeter Medical School(UEMS). We have 4th year students with us throughout the year on their joint Oncology and Palliative Care pathway, 5th year students on extended ward placements which prepare them for life as junior doctors and students undertaking special study modules in topics in research, management and MDT working. All consultants also contribute teaching sessions and academic supervision of students.

Research and Education

Ailise Smith, University of Exeter Medical Student

The hospices have GP trainees placed with us for 4-6 months as part of their training. We are also involved in the training of other junior doctors through teaching sessions and placements.

Specialist education is at the heart of our work. There is a determined team focus to ensure every person is valued, heard and trained and this underpins our enviable standards of care provision. Embedded in all aspects of our education and training is end of life communication skills, nationally recognised as a challenging area of expertise.

To support care delivery the organisation has an active education programme. Last year an education strategy group, chaired by one of our trustees, reviewed and revised the mandatory training for all staff. A programme of role specific training is given on induction to all staff and volunteers .All clinical staff now undergo three full days annually of mandatory training in addition to other topic specific education. Last year training and education was delivered throughout Cornwall Hospice Care to over 130 staff.

Cornwall Hospice Care is also active in supporting and delivering training across the health community. To support end of life care in other settings, 200 registered nurses from care homes in Cornwall were educated in the past year. In 2015/16 we delivered a Partnership Model with Plymouth University “Supportive & Palliative Care & End of Life Care – Enhanced Practice” at both Degree and Masters Level.

Also provided has been bespoke training for the Brandon Trust, a charity supporting adults and children with learning disabilities and autism to live the life they aspire to have.

The Hospices are a placement for nursing students from the University of Plymouth; we were rated as excelling in all aspects of education and support provided in a recent University audit.



Cornwall Hospice Care provides an advice line service for healthcare professionals in any setting in Cornwall, providing specialist advice 24 hours a day, seven days a week. The service now deals with over 700 enquiries per year and numbers continue to grow.

Calls come from community based staff including GPs, community nurses, out of hours and emergency services, nursing homes and community hospitals. The advice line also provides the out of hours palliative care support for the RCHT acute trust.

Most of the calls are seeking advice on symptom control or the most appropriate management of complex patients. They are responded to by specialist nursing and medical staff, and, where needed by our physiotherapy, occupational therapy and lymphoedema specialist teams.

For less urgent situations we also offer an email advice service. This has been invaluable in allowing multiple clinicians involved in complex patient care to liaise and ensure that the patient receives the right advice and care with the minimum of wasted time or multiple appointments. It is run through the NHS mail system to ensure data security and confidentiality.

To further improve and develop the service, we plan to record all advice given onto shared electronic patient record systems as these are implemented in Cornwall.

Advice Line

“The fact that you take care of the patient in the way that you do naturally takes care of the family. You helped them all through the difficult time with grace, kindness and care.”

Priorities for improvement 2016/17

1. Community services – offering service and support closer to home. 2. Community engagement – ensuring services deliver what our users and potential users want; not what professionals think they want.3. Carers – emotional support and practical help to enable carers to cope with the difficult task of looking after a loved one at the end of their life; ensuring carers aren’t “cut a drift” after someone dies.4. Volunteers – harnessing the skills and knowledge volunteers have to deliver services; building on the work of compassionate communities. 5. Education – raising the standard of end of life care for all; not just the small percentage of people we directly touch.


Cornwall Hospice Care nurses preparing for a drug round.


2015 to 16 was a busy year. At the beginning we set ourselves the following priorities

1. To review our service to ensure sustainability and to enable a flexible and effective service: during 2015/16 we have reviewed the nursing establishment on our wards, benchmarking against other hospices nationally. We have developed a competency based skill mix to ensure the highest possible care for patents. We have also conducted a bereavement review to ensure the bereavement services are meeting our users’ needs and are just about to conduct a spirituality review to explore spirituality care in the 21st century.2. To continue to develop our work on patient experience; during 2015/16 we have carried out a full statistical analysis of the data provided by our current outcome measure the St Christopher’s Index of Patient Priorities (SKIPP). This resulted in a poster presentation both nationally and internationally as planned.3. To facilitate advanced care planning for patients known to our service: whilst we have continued to carry out advanced care planning for patients using our service we have currently been unable to facilitate the introduction of advanced care planning by other healthcare professionals.4. To continue to provide education to fellow professionals: in addition to the pre and post graduate medical and nursing training, Cornwall Hospice care has delivered raining to 200 Registered Nurses working ion care homes across Cornwall. We also delivered a Partnership Model with Plymouth University “Supportive & Palliative Care & End of Life Care – Enhanced Practice” at both Degree and Masters Level.5. To work closely with volunteers to extend the services we offer: the Bude Sitting service was launched in January 2016, its aim is to provide respite for carers of loved ones at the end of life.

Update on last year’s priorities

6. To facilitate the standardisation of guidance around palliative and end of life care across Cornwall: Consultants from Cornwall Hospice Care chaired an educational bid with funding from Health Education South West (HESW) to improve patient outcomes with good symptom control at the end of life within Cornwall. A unified Anticipatory Prescribing Guidance (APG) tool was disseminated across all healthcare settings in Cornwall, backed by a programme of education. This resulted in 990 healthcare professionals from all disciplines, and in all settings, being taught in a 10 month period.7. To continue to work in collaboration with other providers and to contribute to the planning, development and review of care across Cornwall: we have continued to give advice and support to other professionals via our telephone and email advice line. Our consultants have also continued to support the weekly Multi disciplinary Team Meetings with the Palliative Care Specialist Nurses across the county, where the management of patients being cared for in the community is reviewed. Members of Cornwall Hospice Care’s clinical team attended the Healthwatch Conference on End of Life Care in January with one of the consultants giving a presentation. Cornwall Hospice Care have also been invited to be part of the recently formed End of Life Strategic Group, which aims to shape and then deliver Cornwall’s End of life Strategy.


“We really are unable to thank you enough for the wonderful care which you have extended to our brother during his stay of the past two weeks. His significant improvement is entirely due to your professional medical treatment and constant attention to his well-being.”


In the year 2015/16 Cornwall Hospice Care admitted 388 patients, aged from their early 20’s to in their 90’s, to the inpatient units and provided 4,939 bed days of care. It cost the charity £629 a day to provide a specialist bed at each hospice. With regards to out-patients, the nursing teams covered 99 day care interventions.

The lymphoedema team dealt with 1,761 out-patients appointments and attended 164 in-patients.

Cornwall Hospice Care Consultants supported 1,266 patients through the community multidisciplinary team’s out-patients.

Cornwall Hospice Care also provides a 24-hour advice line for health care professionals and in this period handled more than 700 calls.

In addition, our consultant activity for community and hospital teams will be included in other organisations Quality Accounts.

The charity received numerous formal and informal compliments and no formal complaints.

The difference we make

“Not long after Sue’s diagnosis we were told that she had been admitted into the hospice. Being 300 miles away and not knowing much about hospices, this frightened the life out of me and my family. I instantly thought that Sue had gone into the hospice because she was

going to die. But, Sue was comfortable, enjoying watching all the birds in the beautiful garden and generally seemed really well, all things considered. When she was admitted at different times over the next 2 years I knew she was in the best place possible to care for her!”

Becca, niece of Sue

What people say about us

Statement from Kernow Clinical Commissioning Group

Kernow Clinical Commissioning Group values the contribution that Cornwall Hospice Care makes in providing high quality end of life and palliative care to individuals and their families in Cornwall. We have been particularly impressed in the work that The Hospice and other partners have developed around ensuring Countywide consistency of approach to Advanced Prescribing and recognise that the resulting guidance has been met very positively by a wide range of individuals. We look forward to working even more closely in the coming years with The Hospice and other partners who we know will contribute generously their time and expertise to help shape the service and pathway improvements for end of life care. We see that the Hospice are an essential partner in this and are keen to working collaboratively to ensure that our commissioning plans develop and are influenced by experts who understand the needs of the individuals they support.


“When my brother Frank had a brain tumour Win nursed him. He went to the hospice a couple of times and she fell in love with the place because we all used to go and see my brother and as well as the care, everyone was so friendly to us all. My son Andrew was also taken

ill with a brain tumour, and was in the hospice for about a month before he passed away and again everyone was lovely.

I wasn’t surprised when I discovered Win had left a gift to Cornwall Hospice Care in her Will. I know she was impressed by the care given to my brother and my son and she clearly didn’t forget that.”

Bill, cousin of Win, brother to Frank and father to Andrew.

“We cannot begin to put into words how to say thank you to all the fantastic staff at St Julia’s. The care and support that you gave to mum and to ourselves was beyond anything that we could have ever imagined. We loved our Mum so much and to see what was happening to her was so cruel. But you made that process so bearable. You are such very special people and we will never forget you.”

“My family and I are so grateful for the tremendous care and support you gave to my husband during his final weeks. Without you his life would not have been so tolerable. I know it helped to keep his spirit alive. Also the care and attention you gave me and my children provided so much support and comfort and more poignantly more quality time to be with him.”

“Knowing he was safe and so well cared for took a huge weight off my shoulders so that I was able to relax and just enjoy our last days together. We both agreed that, except for the reason that brought us there, St Julia’s was the closest place to Paradise that we’d ever been.”

Notes

Registered Charity No. 1113140

Mount Edgcumbe Hospice: 01726 65711

St Julia’s Hospice: 01736 759070

Healthcare Professionals Advice Line: 01736 757707

Shops, Warehouses, Furniture Collections, Ebay, New Goods, Fundraising, Lottery, Media & Public Relations,

Finance: 01726 66868

Hayle Fundraising Office: 01736 755770

www.cornwallhospicecare.co.uk

Documents

Quality account 2015 2016