Agenda item

(To receive a report from Sarah McKown (Head of Clinical Services, Lincolnshire Community Health Services) providing information on the Butterfly Hospice in Boston, which opened to inpatients in 2014, and the planned future developments for the Hospice.  Sarah McKown (Head of Clinical Services, Lincolnshire Community Health Services), Clare Credland (Integrated Services Lead, Lincolnshire Community Health Services) and Linda Sanderson (Butterfly Hospice Trust Manager) will be in attendance for this item)

Consideration was given to a report by Lincolnshire Community Health Services NHS Trust and Butterfly Hospice which provided information on the Butterfly Hospice in Boston.  The Hospice opened to patients in 2014 and the report also included information about the planned future developments for the Hospice.

 

At 11.46am, Councillor J Kirk re-entered the meeting.

 

Sarah McKown (Head of Clinical Services, Lincolnshire Community Health Services NHS Trust), Clare Credland (Integrated Services Lead, Lincolnshire Community Health Services NHS Trust), Linda Sanderson (Butterfly Hospice Trust Manager) and Yvonne Slater (Chair of Trustees, Butterfly Hospice) were in attendance for this item.

 

Sarah McKown (Head of Clinical Services, Lincolnshire Community Health Services NHS Trust) introduced the report which noted that in the Hospice's full year (2015) 106 patients had been admitted.  Admissions had increased to 161 for 2016.

 

At 11.50am, Councillor Mrs P F Watson re-entered the meeting.

 

Following a meeting with 600 Boston residents in September 2000 to discuss the need for palliative care in the local area, a Trustee Board was formed for the Butterfly Hospice Trust.  The Trust was now both a registered charity and a private limited company as this status meant that individual Trustees and employees could not be liable for business debts.  Initial fundraising had resulted in £1.2m being raised, which meant the Hospice could be built and, in March 2009, NHS Lincolnshire committed to commission twenty-two additional community inpatient beds across Lincolnshire for service users identified as end of life. The building opened in 2011 and six inpatient beds were commissioned by Lincolnshire East Clinical Commissioning Group (LECCG) and a three year partnership agreement put in place between the Butterfly Hospice and Lincolnshire Community Health Services NHS Trust (LCHS) in August 2014.

 

Care was delivered with a nurse-led model with GP input.  LCHS provided the nursing care and the Butterfly Hospice Trust agreed to raise the funds to cover all operational and maintenance costs associated with the building.  Chefs and housekeeping staff were also employed and WiFi had also been installed for the benefit of patients and visitors.

 

Key principles of care were followed by the Hospice to ensure End of Life Care Service Users:-

·       Were treated with dignity and respect at all times;

·       Received effective symptom management whatever the diagnosis;

·       Had choice and control over where they would prefer to die; and

·       Were in the company of people who cared about them when they died.

 

The expected outcomes of the Hospice were explained:-

·       Increased quality of life for Service Users through the reduction of distressing symptoms;

·       Increased Service User and Carer/family satisfaction of the service;

·       Increased numbers of Service Users who would achieve their Preferred Priorities of Care (PPoC);

·       Increased numbers of Service Users who would achieve their Preferred Priorities of Death (PPoD);

·       An Advanced Care Plan to be in place for all Service Users;

·       Increased numbers of non-cancer Service Users accessing services;

·       Reduced numbers of deaths in acute hospitals; and

·       Reduced strain and anxiety of Carers in the short term.

 

The referral criteria for the Butterfly Hospice were noted:-

·       The referring clinical professional shall have answered "no" to the 'surprise question' of "Would you be surprised if this Service User were to die in the next six-twelve months?" from the Prognostic Indicator Guidance, the Gold Standard Framework;

·       Service Users wishing to return to their home or usual residence, e.g. care home;

·       Service Users shall be registered with a Lincolnshire East GP Practice; and

·       The Service User had needs identified under one of the following two categories:-

o   Palliative and End of Life/Terminal Care; and

o   Respite Care.

 

Meetings were held on a quarterly basis between the management teams of the Butterfly Hospice Trust, Lincolnshire Community Health Services NHS Trust and Lincolnshire East CCG to review quality issues and Key Performance Indicators (KPIs).  Current KPIs included:-

·       Patient, family and carer experience and satisfaction;

·       Reduction in transfers to acute providers;

·       Increased numbers of non-cancer patients accessing the service;

·       Case management and recognition of GSF;

·       Preferred place of death and care;

·       Length of stay 14 days, review of longer stays and bed occupancy; and

·       Staffing turnover and sickness.

 

Between 11 and 17 patients had been admitted every month with an average length of stay at 10/11 days with admissions from either acute hospitals or the patient's own home.  Patients continued to be predominantly cancer patients for both respite and terminal care and the main referrers from allied health care professionals, community nursing teams and Macmillan and specialist nursing staff.  The Committee noted that fewer patients were referred from GPs and only very small numbers of referrals considered inappropriate.

 

The number of deaths ranged between three and ten per month.  The number of discharges and deaths were reported monthly and those figures included whether the Hospice was the preferred place.  Where it was not possible to ascertain the patient's wishes, this was reported separately.

 

The Hospice was pleased to report that they were in receipt of frequent accolades and had not received any formal complaints or been required to escalate any serious incidents.

 

Challenges and risks for the future included:-

·       Bed occupancy – promotion of the services available to health professionals to raise professional awareness was constantly required;

·       A two-bedded room was available in addition to four single rooms which could not, on occasion, be fully utilised due to single sex accommodation requirements;

·       GPs had been identified who did not utilise the GSF which identified a potential risk of suitable patients not being notified of the services available which impacted on the utilisation of beds;

·       Momentum needed to continue to raise the profile of the Hospice via collaborative work to ensure a sustainable future;

·       The current contract was scheduled to end on 31 August 2017 and meetings had been arranged to progress contracting arrangements and agree future requirements;

·       Criteria for Admission – Consideration was being given to the current restrictions due to GPs in locality to provide flexibility if needed for patients out of area; and

·       Workforce Model – work was ongoing to ensure a sustainable and appropriate skills mix in order to meet the needs of the service and to create resilience within the team.  Active recruitment was underway.

 

The Butterfly Hospice also received income from four shops, two of which were based in Boston, one in Spalding and another in Skegness.

 

The aspirations of the Hospice were to build a further wing which would provide a range of day services and complementary therapies. It was anticipated that the capital appeal for funds would commence in October 2018.  The website was also being updated to enable online ticket sales for events in addition to the ability to make donations online.  Development of existing fundraising events continued and the Trust had employed a full-time Fundraising and Events Manager in addition to a part-time Corporate Grants and Trust Officer.

 

There was potential for growth in the service in line with pathways offered in other inpatient services.  Single intervention pathways were developed for use in Community Hospitals and interventions, including pre-planned infusions or assessments could be safely delivered in the Hospice with the appropriate acute/community arrangements, treatment plans and staff skill mix in place.

 

The Hospice also planned to continue partnership working with a view to increasing opportunities within Integrated Neighbourhood Teams and assurance of sustainable provision for local patients.

 

Members were invited to ask questions, during which the following points were noted:-

·       It was confirmed that Lincolnshire Community Health Services NHS Trust provided the clinical care for the Hospice;

·       In relation to bed occupancy, it was agreed that when looked at in a statistical form, it would appear that the Hospice was never at full occupancy.  However, it was explained that the Hospice was full most of the time.  Should two beds become free, due to the death of a patient or the patient being discharged to home, this could show a 66% occupancy on any one day but earlier in the same day occupancy could be 100%;

·       Despite being fully utilised every day, Nurses within the Hospice regularly consulted the waiting list and palliative care list at Pilgrim Hospital to proactively offer any beds which became available;

·       GP referrals were uncommon as each patient who needed this type of care was considered during palliative care meetings between GPs, community and Macmillan nurses and was the main source of referral;

·       The proposal for future developments was not to increase the bed space within the Hospice but to provide additional facilities including a staff room and shower facilities; a family room to enable families to stay overnight; a larger dining area; and rooms to provide services to the community, for example, pre-planned infusions;

·       Joint work was ongoing with St Barnabas Hospice to consider the public perception in relation to hospices and how that perception could be changed;

·       The income from the four shops was not restricted and was used where needed.  All monies, whether from shops, fundraising, corporate sponsorship or individuals was used for overheads and whatever was left was used for chefs and housekeepers, etc.;

·       Although income had increased significantly over the last year, the Committee was assured that there would be no capital appeal for expansion started unless the Hospice and Commissioners were confident that there was enough income to run those services;

 

At this point of the proceedings Mr P Keeling, Healthwatch Representative, declared that he was a former Chairman of the Butterfly Hospice and was currently the Chief Executive of the Respite Association. 

 

·       There appeared to be a huge gap in services for respite care provision and it was suggested that hospices may be able to amend their constitutions to include the provision of respite care;       

·       Social media was important for the promotion of the Hospice and to provide information for residents who were entitled to the care provided but who were unaware of its' existence and/or that the care was without charge;

·       LCHS were working with a number of care homes within Lincolnshire as well as other partners, including United Lincolnshire Hospitals NHS Trust (ULHT), Lincolnshire Partnership NHS Foundation Trust (LPFT) and social care to ensure that they were also aware of what the Hospice could offer and if any of their patients was suitable for a place;

·       Continued promotion of the Hospice as an option for acute providers was ongoing.

 

The Chairman gave thanks for the presentation and advised that the Committee was reassured that wraparound care was also available to patients and families.

 

RESOLVED

1.    That the report and contents be noted; and

2.    That visits to the Butterfly Hospice for the Committee be arranged.