Agenda item

St Barnabas Lincolnshire Hospice

(To receive a report from Michelle Webb (Director of Patient Care, St Barnabas Hospice) which provides an update on the work of the Hospice to improve and develop palliative and end of life care services for the people of Lincolnshire in partnership with other health and social care providers.  Chris Wheway (Chief Executive) and Michelle Webb (Director of Patient Care) will be in attendance for this item)


Consideration was given to a report by Michelle Webb (Director of Patient Care, St Barnabas Hospice) which provided an update on the work of the Hospice to improve and develop palliative and end of life care services for the people of Lincolnshire in partnership with other health and social care providers.


Chris Wheway (Chief Executive, St Barnabas Hospice) and Michelle Webb (Director of Patient Care, St Barnabas Hospice) were both in attendance for this item.


A five year clinical strategy had been developed to continue to support new and innovative ways of working which would service the needs of patients and also the communities served.  The strategy would also support the hospice in delivering exemplary palliative and end of life care; manage the predicted increase in demand on services; and ensure the hospice remained sustainable in a complex and ever changing healthcare economy.


The organisation continued to be engaged in the Sustainability and Transformation Plan for Lincolnshire and Neighbourhood Teams locally.  The strategy developed by the hospice would support collaborative and cohesive working to support a system leadership approach to high quality end of life care.


Since April 2016, the numbers of patients accessing services from St Barnabas Hospice had increased to:-

·       Hospice at Home – 1692;

·       Palliative Care Coordination Centre – 1465;

·       Day Therapy Service – 1251;

·       Allied Health Care Professional Support – 648;

·       Lymphoedema – 105;

·       Specialist Palliative Care Inpatient Unit – 134; and

·       Hospice in the Hospital – 141.


In addition, 1686 new referrals had been received by the Family Support Service with a current caseload of 514 clients.

The Welfare Service had also opened 3608 new benefit claims with a current live caseload of 75 clients.  Monetary gain from this service since the 1 April 2016 was £726,876.83.


Ambitions of the hospice for 2016 had been:-

·       To support better access to palliative care services closer to home – good progress had been made to support people's choice of dying closer to home.  Work with other providers to support End of Life Care in care homes with a specific project "Hospice in your Care Home" had been developed with five care homes engaging in the project.  Work was also ongoing with Professor Kirsty Boyd of the University of Edinburgh to develop a tool to support lay people in identifying palliative care needs earlier;

·       Education and training for staff – A clinical practice educator had been recruited to support education and training of the clinical workforce.  Senior clinical staff had begun to embark widely on non-medical prescribing to support the ambitions of the strategy.  All nurses would undertake the additional qualification also.  As part of the Commissioning Quality and Improvement Scheme (CQUIN) supported training for all clinical staff and clinical volunteers was ongoing to give a greater understanding of the Palliative Care needs for those living with a learning disability;

·       Development of emotional and spiritual and psychological support for patients and families– an integrated spiritual and wellbeing assessment tool determined on the need of patients and families was being developed.  Many nurses had successfully completed both the foundation and advanced level of Cognitive Behavioural Therapy and Mindfulness courses to provide an increased level of psychological care and support;

·       Supporting Communities to discuss death and dying– the hospice were leading an integrated approach towards dying matters and working with the East Midlands Hospice Group to raise awareness of the issues of breaking the taboo around talking about death.  The Marketing Team at St Barnabas Hospice had supported the development of "The Elephant in the Room", a hard-hitting animation which addressed the subject of dying and was aimed at raising awareness of hospice care within local communities.  Work with local communities, social care and other third sector providers was ongoing to champion the issues around death with a programme of public engagement events to develop local strategies engaging both the hospices' own service users and staff but also those of external providers;

·       Estate sharing – As part of links to the neighbourhood teams, the hospice was continuing to scope premises sharing and was currently considering reciprocal arrangements with the community provider and acute trust to bring teams together to benefit a seamless approach to patient care as well as collaborative working for clinicians;

·       Exploration of the use of technology to better coordinate care – the Electronic Palliative Care Coordination System (EPaCCS) was an electronic method of sharing information about a person's wishes for their end of life care.  The system solution, My Right Care, worked across boundaries to enable information to be shared irrespective of the organisation or time of day.  This enabled health professionals to access important information to assist clinical decision making to ensure that a patient's wishes were known; and

·       Support the acute Trust in Lincolnshire – St Barnabas had recruited an End of Life Care Matron who worked across all three United Lincolnshire Hospitals NHS Trust (ULHT) sites and supported the Specialist Palliative Care Team and End of Life Care Facilitators to deliver education and best practice to patients who were end of life.  St Barnabas was also delivering a CQUIN on behalf of ULHT to the value of approximately £800k.


A number of national developments and initiatives had the potential to impact on the delivery of the clinical services provided by the hospice.  These included:-

·       A consultation by the Care Quality Commission (CQC) on proposals for the next phase of regulation of health and care services in England and included proposals for regulating complex services;

·       The final version of the Palliative Care Currencies was expected to be published imminently.  Currency was a word used by the NHS to describe consistent bundles of health interventions for different groups of patients which could be used to support payment and to inform commissioning.  Within the hospice, work continued to develop the systems to collect this data in order to support its use on an individual patient and cohort basis;

·       Implementation of the Government's national commitment on end of life care (England) following the launch in July 2016 had seen the establishment of a Programme Board within NHS England to monitor progress against actions identified within the commitments document;

·       Conversations continued in Lincolnshire regarding the development of Multi-speciality Community Providers (MCP) which St Barnabas was actively engaged in, in both the East and South West localities;

·       The NHS Contract had now been agreed for St Barnabas and had a duration of two years.  A separate contract covered the Palliative Care Coordination Centre and there was ongoing discussion with South West Lincolnshire CCG regarding the Hospice in a Hospital.  There were some concerns around ongoing funding, lack of contract, nursing model and sustainability;

·       The issue of End of Life Care and the concerns around the lack of focus on this issue within the Lincolnshire Sustainability and Transformation Plan (STP) had been formally fed back via the stakeholder board.  The Chief Executive Officer of Hospice UK had also raised the issue on behalf of St Barnabas with the senior leadership team during a national STP forum; and

·       As a key member of the expert reference group for palliative and end of life care, St Barnabas was supporting and influencing a piece of  work to develop a co-designed end of life care 'pathway' which would support earlier identification of patients with palliative care needs and further reduce the barriers experienced by clinicians in addressing communication, assessment and needs.  Intelligence was also being gathered to identify opportunities to join up initiatives trialled in different areas of Lincolnshire, for example the Care Home "Red Bag Scheme" which supported patients admitted to hospital.


Whilst developing the clinical strategy, areas of inequality had been explored in respect of end of life care, including the national choice agenda.  The strategy was designed to achieve the organisation's three strategic goals:-

·       Reaching Out;

·       Pushing Boundaries; and

·       Sustainable to the future.


Key principles reflected the 'I' statements and articulated within the operational document "What's Important to me?" a review of end of life care by the Department of Health in 2015.


Eight clinical objectives and five programmes of work had been developed which would deliver the organisational goals.  The senior clinical team were confident that the strategy would support the organisation to provide end of life care in a competitive and economically challenging field.


2017 would mark the 35th anniversary of St Barnabas Hospice and a calendar of events and activities had been planned to commemorate the milestone.  These events included a moonlight walk, birthday bake-off and 35 challenges for the Chief Executive Officer.  These challenges included a London to Paris bike ride and giving up all electronic devices for a whole day.  A Thanksgiving Service would also be held in Lincoln Cathedral.


As circumstances in which people die were becoming more complex and challenging, it would be the responsibility of those close to them and the professionals working alongside them to ensure the choice for patients and care continued in Lincolnshire.


NOTE:       The Chairman declared an interest in this item as she had provided financial support to St Barnabas Hospice over the last twelve months.


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

·       The Hospice in a Hospital at Grantham was the only one of its kind operating in the country and was operated on a separate contract with nursing provision from the acute hospital and specialist care from St Barnabas.  South West Lincolnshire CCG was in the process of considering all services so there remained a level of uncertainty for this service.  Although this was a positive story for Grantham Hospital and the county as a whole, the contract renewal had not yet been signed;

·       Clarification was given that spiritual care, chaplaincy services and Cognitive Behavioural Therapy had always been provided but had previously operated as separate services.  These services were now being joined up to provide integrated support to patients and families;

·       The hospice worked closely with the Citizens Advice Bureau, the British Red Cross and also MacMillan Cancer Support for small grants to provide equipment for people to help them remain in their own home for as long as possible.  Links with other services to provide benefits had also been made but it was noted that the largest obstacle for patients and families was the complexity of the forms to complete;


The Chairman wished Chris Wheway (Chief Executive Officer) all the very best of luck for his forthcoming bike ride to Paris.




          That the report and comments be noted.

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