Strategic Plan Outstanding Palliative Care. Strategic Plan

“ Strategic Plan 2016 – 2021 “Outstanding Palliative Strategic Plan 2016 – 2021 Care” 1 Contents 2 Strategic Plan 2016 – 2021 Strategic Plan 20...
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“ Strategic Plan 2016 – 2021

“Outstanding Palliative Strategic Plan 2016 – 2021 Care”




Strategic Plan 2016 – 2021

Strategic Plan 2016 – 2021



Mission, Vision, Values


Our Philosophy of Care


The context in which we operate


Where we are now


Our strategic goals




Making it happen



Introduction It was a source of great pride for the Hospice to become the first adult Hospice in the country to be ranked as “Outstanding” by our regulator, the Care Quality Commission (CQC). The CQC examines how safe, effective, caring, responsive and well-led services are. greatest benefit and best outcomes

this Strategic Plan is aspirational,

for people with life-limiting illnesses

but not unrealistic; ambitious but

in County Durham.

not idealistic; stretching but not

The Plan takes us further down the strategic path we set out on in 2013. We have been able to reflect on what we have achieved in the last three years and look further into the future. This in turn has enabled us to refine and develop our 4 Strategic Goals. There is no shift in

reckless. And we are confident that, if we can achieve the goals we have set in this plan, more people than ever will achieve a “good death”. Wynn Griffiths Chairman

August 2015

the strategic direction we are taking but our thoughts on how quickly we can make progress and on how we can describe and measure our progress have developed. This Strategic Plan builds on our acknowledged strengths to try and ensure we make the best use of the resources at our disposal in the coming years to provide the


Mission, Vision, Values Our mission:

To make every day count for those affected by lifelimiting illnesses

Our vision:

To be a centre of excellence within our community and to provide all-embracing, compassionate and

has considered this plan and has commented on it in draft form. Their endorsement encourages the Trustees in our belief that





individualised care to all those affected by life-limiting illnesses, at a time and a place that is right for them

Our Philosophy of Care At the heart of St Cuthbert’s

We will work together to provide a

We see life – and death – as a

Hospice is the individual who is

warm and welcoming atmosphere

journey to be made in the company

seen as a unique person deserving

that accommodates diverse

of others. We are rooted in our local

of respect and dignity. Our aim is

cultures and lifestyles within a calm

community and we approach life

to support each person and their

and compassionate environment.

and death through a philosophy

family and friends, helping them

As a team, we will strive to provide

based on support and hospitality.

to make informed choices and

care of the highest standard by

decisions affecting their lives.

ensuring staff are up to date with

Individual care is planned to

I am grateful to everyone who

Our values:

current research and training.

support the total well-being of each

We are aware of the valuable work

person, taking into account their

undertaken by individuals and

physical, psychological, social and

agencies in the community and we

spiritual needs.

will work in partnership with them to provide excellent services for the people of Durham.

Strategic Plan 2016 – 2021

Strategic Plan 2016 – 2021


The context in which we operate The overall population of County Durham is predicted to increase between 2011 and 2030 from to 513,000 to 560,700. The County Council predicts that this figure could be as much as 10,000 higher in 2030 if it is as successful as it hopes in attracting new jobs to the County. In the lifetime of this Plan (i.e. by 2021) the population is forecast to increase to 539,000. To put this in context, at any one time it is estimated that 1% of the population should be on the Palliative Care Register. These figures mean that, on this calculation the size of population that needs palliative care in County Durham will have risen from 5,130 at any one time to 5,390 – a rise of 260 people.

“ 6

Everyone is keen to ensure people have a genuine choice about their preferred place of care

Strategic Plan 2016 – 2021

The population in County Durham is becoming older, too. By 2030 there is a predicted increase of 39.8% in older people aged 65 years and over and a 95.2% increase in older people aged 85 years and over. Life expectancy has improved but remains below the England average. (County Durham 77.9 for males and 81.5 for females – England 79.2 and 83 respectively based on 2008-10 figures).

Strategic Plan 2016 – 2021

In the period 2010-2012, cancer accounted for around 41% of all premature deaths in the County, cardiovascular disease (CVD) for around 23% and chronic obstructive pulmonary disease (COPD) for around 18%. The mortality rates for people dying under the age of 75 from cancer and COPD is significantly worse than the England average. There are particular challenges for certain conditions due to increasing age (e.g. dementia) or change in projected prevalence (e.g. diabetes). Projections suggest that the number of people living with dementia in the County will rise from around 6,625 (2014) to 10,896 (2030). Adult and childhood obesity levels in County Durham are worse than the England average.

The Gypsy, Roma and Traveller (GRT) community forms the largest single ethnic minority group in County Durham. According to the 2011 Census there were 467 people from the GRT community, although it is believed that this figure is not a true representation of the actual population number as many Gypsies, Romas, and Travellers will

not self-identify.

The Health Needs Assessment for County Durham and Darlington in 2011 estimated that the GRT population in Durham was between 2,200 and 2,940, which is 0.59 % of the county’s population. Analysis from the GRT Health Needs Assessment suggests that the health of this vulnerable group deteriorates more rapidly in older age than the rest of the population. People from the GRT community appear over four times more likely to die between the ages of 55 and 74 years than the population as a whole. Suicide rates are almost 7 times higher among GRT men compared with men in the general population. The County Durham vision for End of Life Care is “To ensure that people approaching end of life will be able to have a good experience in their referred place of death, be that hospital, hospice or home”. The development of the Health and Well-Being Board, with responsibility for commissioning adult social care services, will drive us to be more specific about which services might be commissioned by social care, which ones by healthcare,


and which ones might be jointly commissioned. “Integrated care” is the current mantra, with many eyes turning to the pilot that has been announced in Manchester to see what this might mean in practice. The funding and commissioning landscape is more complex and we will need to be nimble enough to navigate our way through it. There is cross-party support for a move to more personalised models of care, with some move towards personalised budgets for health and social care. We already have personal budgets in social care. Patient choice is at the heart of this and we must be ready to respond to the demand for more personalised services. We will need to be able to offer as much choice as we can as to where people access services, when they access them and what say they have in designing those services. We will also need to become very adept at describing the impact of those services. There are many informal carers who want to play a more central role in meeting the palliative care needs of the person they care for. They need information and some basic skills to achieve this. There is a continuing need to develop palliative care as a


recognised specialism with high status, which will attract the best doctors and nurses to work in it. There is variable quality of palliative care, in nursing and care homes and in primary care settings and training and development must have a role to play in improving quality and raising awareness of what outcomes can be achieved through the provision of excellent palliative care. Durham County Health and WellBeing Board (DCHWBB) has identified, as a priority, the aspiration to raise the number of people who have prepared an advance care plan, as well as the number of people who get their preferences met. DCHWBB has agreed to adopt and implement the North East Charter relating to a ‘good death’ which aims to provide a guide to those people who are involved with people who are approaching the end of their life, to ensure the right services are available at the right time for individuals who are dying, their families and carers. According to Dying Matters, around 70% of people nationally would prefer to die at home or in their usual place of residence. In Durham, during the period 2008-2010, only

about 41% of deaths occurred at home or in a care home. Although this is higher than the national average (35%) all commissioners are keen to see this figure rise in coming years. Everyone is keen to ensure people have a genuine choice about their preferred place of care and their preferred place of death. For those who choose to die in a Hospice, this is not yet a reality in County Durham. In North Durham, the gap between the number of specialist palliative care beds we have and the assessed need is between 17 and 23 while in Durham, Dales, Easington and Sedgefield (DDES), the gap is 28 and 37. Nationally, 26% of people would prefer to die in a Hospice. In the period 2010-2102, 2% of deaths occurred in a Hospice in DDES and 6% in North Durham. Families are becoming more complex and more dispersed. The traditional model of the majority of care being provided for people with life-limiting illnesses by family is being challenged by this reality. As the number of people with life-limiting illnesses increases, as they continue to live longer and as NHS care continues to face financial pressure, there is a need to consider what role the wider community might play in meeting the growing demand for informal care.

Strategic Plan 2016 – 2021

There are many informal carers who want to play a more central role

Strategic Plan 2016 – 2021


Where we are now St Cuthbert’s Hospice opened its

• A physiotherapy service for


encourage more conversations

doors in September 1988, offering

people who have developed

about death, dying, grief and loss

day hospice provision on two days

Lymphoedema, a condition which

in the community and encourage

per week. In 1999 the building was

can develop as a side effect of

more people to think about how

extended to create new treatment

cancer treatment. This service is

they can promote a good death

rooms and administrative offices.

currently offered to around 300

for themselves, their loved ones

Then, in 2006, the building was

patients per year;

and their communities.

further extended to allow us to open an in-patient unit. All of these developments allow us to offer the services we do today: • In-patient care for up to 10

• A paracentesis service aimed particularly at people with liver

the outskirts of Durham. The


majority of the people we serve

• Family support. The Hospice has a small team of staff and volunteers

palliative patients who need

who provide practical help and

respite nursing care, symptom

emotional support to patients,

control, or end of life care. The

their families and their carers.

IPU is working at, or close to,

This help extends to bereavement


support as families work through

• Day Hospice provision for up to 18 guests at a time who benefit from input from medical and nursing staff as well as volunteers, an opportunity to socialise with other

neurological conditions.

and their carers; • Public education. The Hospice employs a Community Liaison Officer who delivers “Everything in Place” – a project designed to




which are used for training for staff and volunteers as well as providing a resource for the local community. We also completed the creation of a child bereavement suite in 2012. The building is situated in beautiful and peaceful grounds which provide a therapeutic setting for patients and visitors alike.

we need to cover these costs is provided by the NHS. This support has been provided by the North Durham Clinical Commissioning Group (CCG) and the Durham Dales, Easington and Sedgefield

to increase this up to 13 beds. The building also boasts excellent education and training facilities

Strategic Plan 2016 – 2021

organisation. The activity of St Cuthbert’s Hospice, which is a company limited by guarantee (reg no 2208426) is who all give freely of their time to

the organisation. 43% of the income

beds, the building has capacity


work and are vital to the work of the

governed by its Board of Directors,

to provide these services and run

Although registered for 10 in-patient

CCGs Retail

It currently costs £2.3m each year

• Dementia support. The Hospice

and well-being. We run a heart


disease, respiratory illnesses and

of cancer;

supports people with dementia


numbers of people with heart

people who have had a diagnosis

designed to add to their health

highly valued by guests and their

we also work with significant

one. It includes support groups for

employs an Admiral Nurse who

The Day Hospice provision is

have a diagnosis of cancer, but

the experience of losing a loved

guests, and planned activities

failure and respiratory clinics.

The Hospice is situated on


CCG. Around 4% of our income comes from trading activity, mainly the sale of goods and the hire of our educational facilities. 18% of our income is raised through our 8 retail outlets, which rely on the

Strategic Plan 2016 – 2021

generosity of our local community to both donate and purchase the

steer the organisation and ensure it meets its obligations and the needs

stock that is available in them. The

of the community.

remaining 35% is derived from

The Trustees are accountable to the

fundraising. It is the generosity of the local community that established St Cuthbert’s and it is the same generosity that sustains it. Individuals, schools, community groups, churches, companies, trusts and foundations all support us in various ways to ensure we can deliver the services that are needed by the community. We employ 74 staff members, the majority of whom work in our caring services, with the rest providing the support needed to run the services

Charity Commission and the Care Quality Commission. St Cuthbert’s is registered with the Charity Commission (reg no 519767) and the annual reports and accounts of the organisation can be viewed at the Charity Commission’s website ( St Cuthbert’s is also registered with the Care Quality Commission (CQC). The last inspection was in August 2014. This was an unannounced and routine inspection. The report is available on the CQC website (www.

and generate the income. However,

we could not do what we do without

In our Strategic Plan 2013 -2018,

the support of our volunteers. We have more than 360 active volunteers. Volunteers are involved in every aspect of the Hospice’s

Making Every Day Count, we identified four strategic goals. We


have made good progress towards achieving these goals:

minutes) also increased from 1,110 in 2013/14 to 1,316 in 2014/15. Strategic Goal 3 – to create a high quality learning and research programme

We have redesigned our Family Support Service in order to develop and increase access to it.

Our Strategic Goals Strategic Goal 1 – To improve the availability of, access to, and quality of our in-patient Hospice services

We have increased the number of patients admitted to our In-Patient Services from 192 in 2012/13 to 227 in 2013/14. Through a major project, “Transforming the Patient Journey”, we improved the accessibility of our In-Patient Unit.


Our In-Patient Services were rated “Outstanding” by the Care Quality Commission in 2015. Strategic Goal 2 – To transform our other Hospice services We have increased the number of guests in our Day Hospice from 118 (2012/13) to 154 (2014/15). We increased the number of people attending for out-patients

appointments from (277 to 290) in the same period. We have redesigned our Family Support Service in order to develop and increase access to it. This led to an initial dip in the number of counselling sessions in 2013/14, to 562 from 2012/2 (956 sessions). This number began to recover in 2014/15 and rose to 743. At the same time, however, the number of telephone contacts (lasting more than 10

Strategic Plan 2016 – 2021

We organised a Palliative Care Conference in partnership with Durham University in September 2014. Nearly 100 practitioners from across the County came together for educational sessions and for an opportunity to network and consider how the Hospice could support their development in the future. We organised specialist sessions which we opened up across the County. For example, in 2015 we brought an eminent Palliative Care Consultant with a specialism in the care of people with neurological conditions to provide two training sessions. And, during 2013/14 and 2014/15, we worked with staff in nursing homes to help them provide a better service for people with palliative care needs in their care. Strategic Goal 4 – to improve the capability of communities to respond to an increased demand for palliative care. We employed an Admiral Nurse in 2014, a specialist in the care

Strategic Plan 2016 – 2021

of people with dementia, to the Hospice team. As well as helping the Hospice become more dementia- aware and dementiafriendly, our Admiral Nurse is supporting patients and carers in the community to manage dementia as well as they can and access the services they need.

operate and also the learning we have gained from working towards these goals over the last three years.

Also in 2014, we employed a Community Liaison Officer to encourage more people to have conversations about death, dying, grief and loss and to be more involved in the creation of communities where people who have life-limiting illnesses, and those who care for them, feel supported and remain part of that community. Called “Everything in Place” this project is being piloted in Chesterle-Street and is involving people in conversations about estate planning, end of life care planning, and how you have conversations with your loved ones about what would be important to you leading up to, and after, your death.

• Increase our maximum occupancy in IPU from 10 to 13;

Our Strategic Goals We are retaining the Strategic Goals we set in our previous Strategic Plan. But in this Plan we are able to incorporate both what we know now about the context in which we

Strategic Goal 1 – To improve the availability of, access to, and quality of our In-patient Hospice services We will:

• Develop our ability to measure and report the impact of the care we provide as part of our aim to continually provide safer, more responsive and more effective care; • Continuously strengthen our team approach to palliative and end of life care. We already have a strong team made up of people from different disciplines. Strengthening it would mean incorporating other specialist clinical input (e.g. liver, respiratory, cardiac and dementia specialists).This approach is at the heart of the Hospice ethos, emphasising that the best care is delivered when a team works together and beyond their specialisms, with the patient and family at the centre;


• Achieve 24/7 admissions. This would mean moving from the current position where admissions are largely limited to Monday to Friday, 8am to 6pm, to a position where anyone needing an admission, particularly for end of life care, could also be admitted, if a bed were available, at night and at weekends. • We will also explore the possibility of providing additional palliative care beds. This would enable us to stop using the specialist palliative care beds we have in IPU for respite care and, instead, offer this provision in a separate establishment. It would help us in discharging patients who need nursing care but do not any longer need the specialist palliative care we provide on IPU. It would also help us to model what we consider to be excellent palliative care in nursing homes as an example of what can be achieved in residential care. Strategic Goal 2 – To transform our other Hospice services We will: • Increase the capacity of our Day Hospice;


• Offer a broader range of supportive and therapeutic services which add to the quality of life of people with life-limiting illnesses and enable people to remain independent longer. • We will explore the possibility of delivering personalised, holistic palliative care services to people who want to stay at home in a setting of their choice and at a time of their choice. We will also explore the possibility of acquiring additional land or property to enable us to develop our services further. Strategic Goal 3 – to create a high quality learning and research programme We will: • Develop a network of palliative care practitioners across the County; • Develop training and development opportunities aimed at professionals, carers, and patients. • We will also explore the possibility of partnering with a University/ Hospital and others to develop a practice-based research programme.

Strategic Goal 4 – to improve the capability of communities to respond to an increased demand for palliative care. We will: • Create public discussion about end of life care that will encourage people to think ahead about their own needs and preferences, as well as consider the wider needs of their community; • Support the development of community initiatives to meet the palliative care needs of people in the County and help individuals and whole communities to withstand the impact of an increasing number of people who are living with life-limiting illnesses and who have suffered bereavement and loss. • We will also explore the possibility of developing more services in the community, either in people’s homes or closer to their home, either alone or in partnership with other agencies. As part of this, we will investigate what role technology can play in assisting people to receive more services at home.

Strategic Plan 2016 – 2021

Impact The main impacts we would expect

• An increase in patient

to see happen by pursuing these

satisfaction with the choices

objectives are:

offered to them and the say they

relatives, friends and carers.

have in what happens to them.

• An increase in the number of people who have an advanced

exercise of choice, support for

• An increase in carer satisfaction with overall care in the last 3

care plan • An increase in the number of people who die in the place of their choice, with a reduction in emergency admissions to hospital

months of life, including coordination of care, relief of pain and suffering, care and support in the last two days of life, decision-making and the

Making it happen All of these proposals will be

implementation. We work to a

see how what they do contributes

subject to separate business

planning cycle that ensures every

to the achievement of this Strategic

planning exercise before

member of staff and volunteer can


Planning level

Who is responsible


Vision and values



Strategic Plan

Trustees and Senior Management Team

5 years (rolling)

Operational Plan

Senior Management Team and Manager

3 years (rolling)

Annual Plan

Managers and Teams

1 year

Individual Objectives

Managers/Individual Staff and Volunteers

1 year

Strategic Plan 2016 – 2021


St Cuthbert’s Hospice, Park House Road, Merryoaks, Durham, DH1 3QF Tel: 0191 386 1170

St Cuthbert’s Hospice is a registered charity (reg no 519767) and a compnay limited by guarantee ( reg no 2208426)