Contents
Part 1 – Welcome and Introduction
Chief Executive - Statement of Quality
Who we are and what we do
•
The Aims
•
In-patient Care
•
Out-patient Care
•
The Rehabilitation Team
•
Patient Statistics
•
Education
•
Communication Skills Training
•
Statement from the University of Plymouth
•
Collaborative Working and Education
Part 2 – Priorities for Improvement 2015/16
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•
•
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Therapy Priorities
Priorities of the Rehabilitation Team
Collaborative Working with Others
Joint Working with Specialist Teams
Part 3 – Advice Line
Part 4 – Volunteer Involvement
•
Bude and Stratton Volunteer Sitting Service
Part 5 – Research and Education
•
•
•
•
•
•
Research
Post Graduate Training
Audit Programme
Support to General Practice Trainee (ST4)
Research and Training
I-want-great-care Questionnaire
Part 6 – What People Say About Us
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•
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What our patients and their families say about us
Visit reports
What others say about us
Part 7 – In Conclusion
•
Statement of Assurance from the Board of Trustees
Welcome and Introduction
Chief Executive’s Statement of Quality
Welcome to the third Quality Account
produced by Cornwall Hospice Care. This document
is produced as a statutory requirement
because Cornwall Hospice Care receives a small
amount of funding from the NHS. It is also a
means of helping the users of our services and
other stakeholders to see how we work and how
we intend to develop our services for the people of
Cornwall and the Isles of Scilly.
Our theme for this report is sustainability.
We face a combination of pressure on income and increased demand for our services that must
inevitably lead to consideration of the model of care that can realistically be provided in the future.
The impact of a fall in legacy income, intense competition in fundraising and the dubious honour
of being one of the lowest NHS funded hospice providers in the country creates a challenging
environment in which to operate a charity that endeavours to be at the forefront of care in our
community.
Despite this scenario, we continue to provide the highest possible quality of specialist palliative care
at our two hospices, Mount Edgcumbe, St Austell and St Julia’s, Hayle. At the time of writing, we
provide consultant-led medical care to the Royal Cornwall Hospitals Trust, Cornwall Partnership Trust
and the Peninsula Community Health as well as to nursing homes in the county. We are the main
employer of medical staff qualified in specialist palliative care in the county. We continue to operate
a 24 hour specialist palliative care advice line which is relied on by the healthcare community
including the doctors’ out-of-hours service.
During the course of 2015/16 this provision will need to be reviewed and difficult conversations held
with our partners as to how this support may be sustained into the future.
We do, however, expect to continue to provide our well established and well used lymphoedema
service, which is funded by the Kernow Clinical Commissioning Group.
We have capacity to provide out-patients appointments in excellent facilities but extraordinary as it
may seem, as yet these facilities remain un-commissioned by the NHS.
Medical education is provided to the Peninsula Medical School (University of Exeter) under a
separate funded contract which has steadily grown and remains very successful for both parties.
Our commitment to quality is underpinned by a clinical governance structure that includes a Board of
Trustees, a number of whom are highly experienced clinicians. Those with a medical background are
involved with a Clinical Services Committee and a working Clinical Governance Committee. Cornwall Hospice Care is a charity and raises 85% of funds from voluntary sources, with only 15%
funded by the NHS. This is significantly less than neighbouring hospices in Devon receive and well
below the national average of 30%.
We are grateful to the people of Cornwall who continue to support us and to ensure that our Board
of Trustees is able to commission high quality services on their behalf. I am proud of the staff and
volunteers who have delivered these achievements. I am pleased to be able to present the Quality
Account for 2014/15 and hope that you find it interesting and demonstrative of the high quality of
our services.
Paul C Brinsley
Chief Executive Officer
Who we are and what we do
The Aims
“All the staff strived and worked so hard to make sure that John was given
every opportunity to be comfortable and to enjoy the last few months of his
life.”
Diane, #HospiceStories story teller
Cornwall Hospice Care is a registered charity committed to providing Specialist Palliative Care (SPC)
and End of Life Care (EoLC) for complex patients, over the age of 18 years, irrespective of diagnosis.
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.
In-patient Care
“We can’t make them be better, but we can make them feel better.”
Sam Pleasants, Sister at St Julia’s Hospice
#HospiceStories story teller
We have two in-patient units, at St Julia’s Hospice in Hayle and Mount Edgcumbe Hospice in
St Austell, providing 22 in-patient 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 around a week, but this varies a great deal depending on patient
needs. 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.
Out-patient Care
“A couple of Christmases ago I was being/feeling so sick that the slightest
smell would trigger it. Friends were lovely, bringing gifts of non-smelly
flowers and Christmas Day was approaching. Dr Stevens sat in our living
room discussing how to get round the turkey smell and how the only solution
seemed to be to barbeque it!”
Sara, #HospiceStories story teller
We provide a 24 hour/7 day 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. 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
meetings, phone advice and joint consultations in the hospice or patients’ homes.
We work closely together with the palliative care team at the Royal Cornwall Hospitals, with the
teams at the community hospitals throughout Cornwall and with the Community Specialist Palliative
Care Nurses. 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 out-patients at the hospice units by referral from GPs or
hospital consultants. Our specialist lymphoedema and physiotherapy teams see out-patients at both
hospice sites.
We are able to offer out-patient treatments including blood transfusions and some drug treatments
and procedures. This service is currently only available at Mount Edgcumbe Hospice though we hope
to extend it in the future. Referral is by GPs or hospital teams.
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.
The Rehabilitation Team
“During her time at the hospice they
managed to control all of her horrible symptoms and
for the first time in months,
we all felt safe knowing she would be looked after.”
Jessica, #HospiceStories story teller and Cornwall Hospice Care employee
Cornwall Hospice Care offers a rehabilitation service to both in and out-patients Monday to Friday.
The Team consists of Complementary Therapists, Lymphoedema Clinical Nurse Specialists,
Occupational Therapists and Physiotherapists. Patients attending for out-patient reviews have the
opportunity to see a number of expert professionals in a single appointment, thereby saving patients
and carers much time and energy involved in having to attend several appointments on different
days.
The team works in partnership with colleagues in acute and primary care settings, aiming to provide
the best possible care. Helping patients and families cope with the impact of their disease, and
enabling people to live well and function to their maximum ability is paramount.
Safety of patients whilst in our care is of utmost importance. A year-long audit of patients who
sustained falls whilst they were in-patients showed that the majority were due to increasing
weakness and a fierce determination for people to remain as independent as possible, particularly
related to personal care. New falls assessment tools have been introduced to help identify patients
who are more at risk of falling. An information leaflet is offered on admission which discusses our
responsibilities to keeping people safe whilst in our care and also how they might best help
themselves to prevent falling.
Patient Statistics 2014/2015
In the year 2014/2015 Cornwall Hospice Care admitted 441 patients, aged 18 to 95 to the inpatient units and provided 5,225 bed days of care. It cost the charity £566 a day to provide a
specialist bed at each hospice. With regards to out-patients, the nursing teams covered 120 day care
interventions. The lymphoedema team dealt with 1,992 out-patients appointments and attended 231
in-patients. The medical staff also provided 72 domiciliary out-patient assessments, seeing people in
their own homes.
Cornwall Hospice Care Consultants saw 631 out-patients at Royal Cornwall Hospital Treliske. They
were also an integral part of the hospital’s palliative care team, which provided 4,351 face to face
contacts during the year.
Cornwall Hospice Care also provides a 24-hour advice line for health care professionals and in this
period handled more than 800 calls.
The charity received numerous formal and informal compliments and no formal complaints.
Education
The hospice is a major contributor to clinical placements, teaching and supervision at the Peninsula
Medical School (University of Exeter). 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.
The hospices have GP trainees placed with us for 4-6 months as part of their training and a specialist
Palliative Medicine trainee. 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.
Our education packages are numerous and include all mandatory training required to keep our
highly skilled clinical staff at the top of their specialist care fields. Other vital courses centre on
palliative care drugs (use, suitability and patient safety) and specific advancement courses, including
Train the Trainer.
Education within Cornwall Hospice Care is a constantly evolving process and our training provides
the foundation for our future. We plan to increase the provision of internal and external training
collaborations with the key aim of enhancing specialist palliative care and end of life care.
Our education programmes are also benefiting care providers outside our charity, bringing a vital
income stream. In the last 12 months we have trained 130 Registered General Nurses from care
homes across Cornwall in the use of high-risk medical devices, palliative care drugs and end of life
care.
“Very inclusive, felt like we were sharing best practice rather than being conventionally lectured.
Learnt a great deal.”
We have also shared our specialist palliative care training with emergency care practitioners from
SWASFT (South Western Ambulance Service NHS Foundation Trust). “Totally absorbing. Loads of interaction and excellent insight into palliative care. Superbly
presented.”
On top of this 25 acute-care dementia staff working across Cornwall have also benefited from our
tailored education packages.
Key knowledge strands were also shared with volunteers from Cornish charity ‘Penhaligon’s Friends’
who support bereaved children, young people, parents and carers throughout the county. “Good combination of information (facts etc), real scenarios and contacts with families and practical
activities.”
We have also provided 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 charity supports student placements via Plymouth University, having built up a reputation for
highly skilled and qualified mentors. Dr Jenny Morris (SFHEA) is the Associate Professor
(Senior Lecturer) in Health Studies.
“The evaluations from our students at all stages in their training has been consistently positive, which
demonstrates the high standard of education and training they can expect to receive from Cornwall
Hospice Care. Furthermore, the liaison between Cornwall Hospice Care and the University has been
exceptional.”
Communication and the need to foster a better understanding of hospice care has prompted an
extension of the education package to include young people. Here’s the comment of one teenager
from a Cornish Community College;
“Hospices aren’t just for old people. I did actually think it was a dying place but it’s much more. The
hospice is a positive place to go if you are an in-patient.”
Communication skills training
The hospice continues to provide communication skills
training to a range of groups, from volunteers and
non-clinical staff to senior clinicians. We were
successful in gaining a Health Education England grant
to trial a specific Advanced Communication Skills course
for senior specialist trainees. This course received excellent
feedback and we are reviewing how it might be made more
widely available.
Statement from University of Plymouth
Cornwall Hospice Care has provided
placements for our pre-registration student nurses for over
15 years. This period included several curriculum changes
including the move from a Diploma in Higher Education
to a BSc Nursing award when nursing became an all
graduate profession. Cornwall Hospice Care has supported students across
all three years of their programme and has ensured that
the clinical staff mentor our students to an exceptionally
high standard. The evaluations from our students at all
stages in their training has been consistently positive which
demonstrates the high standard of education and training
Third year medical students Sandiso Moyo and
they can expect to receive from Cornwall Hospice Care. Furthermore, the liaison between Cornwall Hospice Care
and the University has been exceptional, enhanced when
an Education Co-ordinator was appointed to cover both
St Julia’s Hospice and Mount Edgcumbe Hospice; this has
resulted in greater efficiency in the relationship between the
University and Cornwall Hospice Care. Through the Education Co-ordinator an increased number
of staff from both hospices have been successful in
completing a post-qualification evidence-informed decision
making module at level 6 which has added to the quality
of the input to our students.
Dr Jenny Morris (SFHEA)
Associate Professor (Senior Lecturer) in Health Studies
Faculty of Health and Human Sciences Plymouth University
“The Hospice is a very beautiful, peaceful and
welcoming place. However, it is the staff and their
exceptional prefessionalism which will remain in
our thoughts.”
Chris Redd spent two weeks as part of their management training, looking at how our charity
communicates. They explored words that will help
people understand our work and not be fearful of
what we do. As part of their project they asked a
range of people inside and outside the charity to
document the words they would
associate with our specialist care.
Collaborative Working and Education
Over the past year we have been working with Dr Bradley Medlock (GP partner based in Mullion)
to explore how we may best help GP practices to deliver optimal care to patients with palliative care
needs.
We performed an electronic survey to all GPs in Cornwall with a good response rate (167 replied).
GPs explained that they found the support of the hospices extremely helpful, for both inpatient care
and then use of the advice line. GPs also described the current challenges of accessing medications
for patients who experience new or worsening symptoms when they are at home.
We therefore explored models that have been used nationally to try and overcome this scenario.
The concept of a “Just in Case Box” (JICB) has been introduced into many areas of the UK to enable
quick and effective relief of symptoms for patients who are at home. In addition, it has been shown
to reduce inappropriate hospital admissions and unnecessary contact with out of hours services (and
thus cost of services).
Alongside Dr Medlock, we developed guidance and the necessary approvals to enable this to be
piloted in the Penwith GP Practices and delivered an education programme to each GP practice
within this area. This service will be formally reviewed by Dr Medlock, but we have had the following
informal feedback from GPs:
“Patients feel very reassured to have this medication in the house. It can also open discussions
around end of life which may not have been broached before.”
Local GP.
“It (JICB) was useful as indeed the patient went on to need a syringe driver late in the weekend, so
the medications were there for SERCO (out-of-hours provider). It gives us peace of mind that there
would be no delay in pain/symptom control should the need arise.”
Local GP.
This work has given us the foundation for considering the dissemination of the same simple symptom
control guidance across all care settings in Cornwall. This is a focus of priority for the next year.
Priorities for Improvement 2015/2016
“The care and compassion was outstanding. Alongside the professionalism
was warmth. Victor and I were able to be “Victor and Bernadette” again while
at the hospice, rather than patient and carer.”
Bernadette, #HospiceStories story teller
1.
Review our services to ensure sustainability in the future to enable a flexible and effective
service for those that need us.
2.
Continue to develop our work on the patient experience with outcome measures. During
the following year, we aim to consolidate the work we have done on the use of outcome measures
in the in-patient hospice setting. We aim to provide a full statistical analysis of the data provided
by the current outcome measure used and work with national guiders in this area to ensure we
are capturing the experiences of patients in the most meaningful way. We also aim to produce
a patient/family carer information sheet about the use of outcome measures to try and improve
completion rates. We will share our experience with other hospice providers by presenting our data
at national and international conferences.
3.
Facilitate appropriate advance care planning for patients known to our service.
4.
Continue providing education to our fellow healthcare professionals.
5.
Work closely with volunteers to extend the services we offer.
6.
Facilitate the standardisation of guidance around palliative and end-of-life care in different
care settings across the county.
7.
Continue collaborative and integrated working with other providers of specialist and generalist
palliative care within Cornwall. We continue to be committed to seek, promote and support
integrated working with other care providers locally. We will continue to build on joint working
arrangements in all settings and across different patient groups. We will also continue to contribute to
the planning, development and review of services in Cornwall through participation in the Cornwall
Clinical Forum, Commissioning events and any other fora open to us. To improve communication,
safety and integrated care for our patients, we will work with shared IT systems to make our
discharge and outpatient letters, and records of clinical advice line calls available to other clinicians
as part of the patient’s core record.
Therapy Priorities for 2015/2016
“I started having acupuncture at the hospice to deal with ‘hot
flushes’ / down pours! They then kindly carried on with out-patient
appointments, coming to our home. I was sceptical at first, but it
works and I get the opportunity to talk through any worries or
concerns. I have had many panics that Michelle has acted on and
sorted for us.”
Sara, #HospiceStories story teller
As we look towards developing the rehabilitation service further over the forthcoming year we will
build upon work that has already been embarked upon, with continuous review of measures put in
place to ensure they become fully embedded in practice. The promotion of dignity and safety of
patients is a core aspect of our patient care.
The therapists aim to continue to provide a high level of specialist knowledge, training, education
and awareness around palliative and end of life care, working in a collaborative way with other
health care professionals involved in patient care and sharing expertise and experience.
Priorities of the Rehabilitation Team
A project looking at therapeutic interventions is also underway. ‘Occupational restoration’ looks at an
individual’s function and the roles that are meaningful to them. We strive to help people
maintain their self-esteem and enable a person to re-engage in meaningful activities that perhaps
they had lost due to the symptoms and consequences of their illness. The therapists review how data is collected and how meaningful it really is, but collecting numbers
alone does not give us information about the complexities of their roles and the treatments they may
use. Each team member has begun producing quarterly case studies as a means of illustrating the
work they undertake. This should build into a resource of qualitative information about the treatments
and work we do with patients, with a real rich deep insight into what might be
involved in caring for hospice patients as therapists.
“The hospice is like my second home. I know I’ve
got their massive support and that helps take the
fear away and gives me the strength to fight the
illness and the confidence to face it. They worry
about what’s round the corner so I can face each
day and take every day as it comes and enjoy
myself, doing things like sailing.”
George, #HospiceStories story teller
Collaborative working with others
Cornwall Hospice Care continues to provide specialist support to the Community Specialist Palliative
Care (SPCN) team with regular and consistent input to all three Multidisciplinary Team Meetings in
the county. We have standardised the discussion of all new patients and those with challenging/
complex symptoms by developing and using a standardised document. This includes important
details such as estimated prognosis, phasing score and goals of intervention to ensure individualised
care plans and appropriate advance care planning for all. This was disseminated to the whole
county based on a pilot in the west of the county.
We have agreed to take the overnight calls of advice to healthcare professionals (which previously
were taken by the SPCN) via the 24 hour advice line to avoid duplication of services. Our Specialist
Registrar in Palliative Medicine has provided joint visits to patients with complex needs with many of
the specialist palliative care nurses, providing palliative care medical reviews in the community and
enabling further education of the nursing staff.
We have continued to facilitate integrated working within the acute hospital (Royal Cornwall Hospital
Trust) to ensure there is consultant review of patients when required. We have piloted integration of
the consultant timetables, and will continue to strive to ensure the sustainability of this during the next
year.
We have worked hard to overcome some of the obstacles to working with several providers and
recently gained a Health Education South West grant for an End-of-Life facilitator role which we hope
will concrete these integrated working relationships.
We have continued to work closely with the specialist dementia teams in Cornwall.
“The hospice went from being the scariest word you could hear in the world, to
being something that was just safe. Jasmine (dog) could go to the hospice so we
could be a family in Kim’s room, and having the dog there makes such a tremendous amount of difference.”
Jon, #HospiceStories story teller
Joint working with specialist teams
We continue to work closely with specialist teams to explore how we can work jointly to support the
specific needs of different patient groups. Our work with the specialist dementia team in the Cornwall
Foundation Trust is now being linked into countywide joint working on end of life education and care
planning.
Work with the Motor Neurone Disease coordinator has now helped establish regular MDT
meetings covering the whole county and involving all key professional groups. We have developed
documentation to safely and effectively share the outcomes of these meetings.
Advice Line
The hospice continues to provide the 24 hour advice line service for all healthcare professionals in
Cornwall and has now taken on the weekday out-of-hours advice role previously provided by the
community palliative care nurses. The service has also been extended to provide an email advice
service for less urgent queries with consultant staff providing a response within 24 hours. This service
has been used on more than 800 occasions over the year. This is often particularly helpful with
complex patients with multiple professionals involved as a written record of advice and plans can be
shared with all who need to be aware.
To further improve information sharing, the hospice has worked with Cornwall IT Services to develop
templates for sharing advice line records and clinical letters on the acute trust clinical system so that
they form part of the patient’s core clinical record and are easily available to clinicians involved in
their care. This should facilitate clear communication and smoother transfers of care for patients.
“This is a fantastically helpful service .. I have used it on several occasions. Thank you to the doctors
who provide this … it makes dealing with palliative care in the community much easier … especially
out-of-hours.”
Local GP.
Volunteer Involvement
Bude and Stratton Volunteer Sitting Service
Cornwall Hospice Care are supported throughout Cornwall by nineteen volunteer fundraising support
groups who work tirelessly throughout the year, not only raising our profile but also much needed
funds.
At the volunteer fundraising support groups meeting on 19th March 2014 it was suggested that
management meet with the individual groups to increase awareness of our current services, discuss
any local issues and look at opportunities where we can be involved in the community.
The aim to visit each support group and gather local information to help coordinate our future
strategy planning by understanding and engaging in the care needs in each area, is ongoing.
The Bude and Stratton group priority is to implement a volunteer sitting service for patients with
life-limiting illness in their locality. Consultation meetings were set up with the team leader of the
Specialist Palliative Care Nurses in the north of the county, the district nurse team leader and
community Matron, as well as Stratton Medical Centre team and Neetside Surgery. It was found
there was a need for such a service and a course of action was set in motion to implement a pilot
sitting service.
The criteria for referral and documentation is being agreed with the Bude/Stratton clinical teams and
we are now at the stage of advertising for volunteers in the local press.
Two members of the Bude fundraising group, Jenny Westaway and Jo
Symon, collecting an award at our Volunteer Thank You Day
at Eden Project, March 2015
Once appropriate volunteers have been recruited and trained, the service will be open for referrals,
commencing for a trial period of one year. The Chair of the Bude support group in conjunction with
the Cornwall Hospice Care’s Volunteer Services Co-ordinator will manage the service.
Our representatives continue to attend volunteer fundraising support groups and aim to address
as many highlighted issues as possible, to provide much-needed services in local communities
throughout the county.
Research and Education
Research
“Even when Dad was unconscious, the nurses would come in and whatever
they were going to do, they would talk to him and say “good morning David”
we will never forget that kindness as it helped us such a lot.”
Pat and Nicola, #HospiceStories story tellers
We are passionate about the experience and outcomes of care given to patients through their eyes.
We have therefore been collecting patient-related outcome measures (PROM) for several years with
the use of a validated questionnaire exploring symptoms and quality of life (St Christopher’s SKIPP).
However, there is little in the literature to guide us as to how many patients are able to complete
these (as patients may be too unwell to do so) and thus whether they are able to meaningfully
measure the care experience patients receive. We therefore explored this with the help of four senior
medical students. Over 185 consecutive admissions to both hospices, 150 stayed more than 4 days
and thus a SKIPP was considered. Of these, approximately 60% of patients completed a SKIPP
questionnaire. The reasons for non-completion were the patient being too unwell, too distressed or
confused.
We are currently analysing the data, which will be considered during the next year to try and
maximise the patient experience. The following are examples of additional written quotes by the
patients who completed the questionnaires:
“The kindness of staff helps no end when I feel in pain.”
“Extremely pleased with all care received at hospice.”
“I think the care is great.”
“Very grateful to be here, feel safe and well looked after.”
“Secure with all the staff – tremendous help.”
“The care I am receiving is second to none.”
“It has been marvellous at the hospice.”
“Since I have been here I feel a great improvement.”
“Couldn’t be in a better place – the care here is fantastic.”
“Had fantastic care from all aspects of my hospice care.”
Recent comments from patients at both St Julia’s Hospice and Mount Edgcumbe Hospice
We are actively taking part in a collaborative research project with Gloucester NHS Foundation Trust
to explore the views of informal carers towards the use of intrathecal analgesia. We have been able
to significantly drive this project forward due to the number of intrathecals that have been placed for
analgesia in Cornwall Hospice Care. Recruitment is taking place and we are analysing the results
which will be published and presented at international conferences in due course.
We have also taken several roles in supporting others to do research. During the past year we have
worked collaboratively on a national study to explore teaching to medical students in the UK. This
work has been presented at a national conference and publication is in progress. We have also
supported Palliative Medicine trainees in the Peninsula Deanery who have explored looking at the
needs of all junior doctors in Devon and Cornwall in caring for the dying. This has been submitted
for conferences and written for publication. We have supervised medical students at the Peninsula
Medical School to explore the use of outcome measures in the hospice setting and hope this may be
disseminated. We have also been involved in research exploring the goals of patients and healthcare
professionals in the management of pain and goal setting for patients with palliative care needs. We
hope to continue similar research work in the future to endeavour to improve the care given to our
patients.
Post Graduate Training
We actively support post graduate medical education. A senior trainee in Palliative Medicine is
completing her specialist training with Cornwall Hospice Care, gaining wide-ranging clinical and
managerial experience. A total of five GP trainees learn with us on placements each year; two
rotating on six month placements at St Julia’s Hospice, and three on four monthly placements at
Mount Edgcumbe Hospice. These placements give the trainees valuable knowledge and skills to
manage their patients with palliative care needs in the community. We also welcome trainees from
other medical specialties, eg Health Care of the Elderly, on shorter placements. Our education
programme extends to bespoke teaching sessions for the junior medical staff at RCHT, and includes
our involvement in GP training events throughout the year.
“Mount Edgcumbe Hospice is a fantastic place to undertake a palliative care placement. I was
fortunate enough to experience 4 months there during my second year of GP training. Not only was
I made to feel like part of the team but was also integrated clinically; given the opportunity to see my
own patients, spent time with the community MDTs and time was made for one on one teaching and
training with the consultants.”
“The hospice is obviously a very special place, echoed frequently by patients and their families, but
it also takes pride in its trainees and I would thoroughly recommend it as a placement for clinical
practice.”
Audit Programme
Cornwall Hospice Care undertake Clinical Audits and Quality Monitoring to ensure compliance with
the Care Quality Commission. The Clinical Governance meetings prioritise the audits across the
Clinical Services.
We are presenting significant audits that inform the basis of our aspirations in our Quality Account.
The Clinical Governance group now oversees a rolling program of clinical audits across all areas
of practice. This allows both a robust regular audit cycle in core areas of practice such as referral,
assessment, prescribing and prompt response to safety alerts or changes in guidelines or practice.
Clinical Audit Programme 2014/2015
Support to General Practice trainees (ST4)
We have supported a GP trainee to carry out an important piece of work around the current
challenges of delivering end of life care to all patients in the community. This included a survey to
GPs and nursing staff and a needs analysis. As a result, it was identified that anticipatory
medications would be helpful to improve symptom control in the community and enable patients to
stay in their own homes as they approach the end of their life. Through extensive collaboration, we
have supported the roll out of JICB in the Penwith area. If this pilot is successful it is envisaged that it
will be rolled out across Cornwall.
Using our consultant expertise we have introduced the trial of anticipatory prescribing with the siting
of “Just in Case Boxes” in patient’s homes in West Penwith. This will ensure timely control of distressing symptoms. Evidence from other services evaluated in other areas of the country are that “Just in
Case Boxes” (JICB) also prevent admissions to acute services and help ensure death in the preferred
place of care for the patient.
Research and Training
In May 2014 the ‘Spinal Analgesia Study Day’ was run by the Integrated Pain and Palliative Care
Team, combining the expertise of the Royal Cornwall Hospital Pain Team and Cornwall Hospice Care
multidisciplinary team. The day was run for palliative medicine doctors training in the Southwest
region, who have difficulty getting experience in managing spinal analgesia in other parts of the
region. The teaching faculty included palliative and anaesthetic consultants, St Julia’s Hospice senior
nursing staff and the Simulation team. We used mixed teaching methodology with presentations and
small group practical and interactive sessions. The feedback from participants was very good and
the day was recognised for training by the Royal College of Physicians.
I-want-great-care Questionnaire
From July 2014, Cornwall Hospice Care commenced a year of trialling I-want-great-care
questionnaires.
Generating positive comments the I-want-great-care responses identified that patients are confident in
Cornwall Hospice Care staff who they feel are delivering exceptional care in a respectful and
dignified manner, sharing that if circumstances arose they would not hesitate to recommend the
hospice service to family and friends. The care environment in both units is viewed as comfortable,
homely and clean with nutritious, appealing food, whilst the surrounding gardens are beautifully
maintained and restful for patients able to access them.
A major concern was that the response would all be positive, which, whilst this is satisfying, would
not give room for implementation of possible enhancement of the service. However, patients and
carers perceptibly felt comfortable completing the questionnaires and confidentially voiced areas
which they felt required addressing.
”When I came in I was consumed with pain. Now I feel positive and am going home to live life with
enthusiasm.”
What People Say About Us
What our patients and families say about us
“There are no words to express what you did for our Mum and us. You all deserve medals for the
care and compassion you not only gave to our Mum and to all of us making the painful time more
bearable.”
“Words cannot express my feelings of gratitude and huge respect for every one of you. Death is
hard to bear but with your kindness, expertise and caring, you made my darling Liz’s passing as
peaceful and comfortable as is possible. She could not have been in a better place. The physical
surroundings and facilities of St Julia’s are truly wonderful, but pale into insignificance compared
with the love, care and patience of all who work there.”
“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!”
“John and we received care which was second-to-none at the Hospice. There was simply nowhere
better that he and we could have been. In spite of everything that was going on, we were enabled
and encouraged to make happy memories together. We were able to enjoy a very unexpected and
special last Christmas together, and who would ever be able to forget all those takeaways? We
remember far more laughter than tears for our time spent at St Julia’s.”
“I would like to put on record our great appreciation for all the kindness and consideration that
has been shown to us by the staff at St Julia’s and also for the excellent care that has been given to
my wife. The team at St Julia’s are true professionals and the Hospice is a ‘beacon of excellence’ in
every way.”
“He was quite poorly, in pain and thanks to the dedication and expertise of the staff, he has made
amazing progress and will be going home today.”
“The excellent level of attention and kindness shown was very comforting to us all. It is comforting
to know that Pam had such good facilities and a lovely garden to look upon in her final days.”
“Your work is invaluable and we will do all we can to support you.”
“We appreciate everything each one of you have done. St Julia’s is like a slice of Heaven on Earth
and you are all Angels!”
What our Regulators, Care Quality Commission say about us
Cornwall Hospice Care (Mount Edgcumbe Hospice & St. Julia’s Hospice) is registered with the Care
Quality Commission (CQC) under ‘Other Independent Healthcare’ provider in line with the Care
Standards Act 2000.
Registered to provide the following regulated activities under The Health and Social Care Act 2008:
•
•
Treatment of disease, disorder or injury Nursing Care
Cornwall Hospice Care is subject to periodic reviews by the Care Quality Commission, the last of
which was on the 5th August 2014 at Mount Edgcumbe Hospice, and the 14th December 2013 at
St. Julia’s Hospice.
Cornwall Hospice Care has not participated in any special reviews or investigations by the CQC
during the reporting period.
The Board of Trustees also has an annual programme of Provider Visits under which two Trustees visit
each unit twice yearly. All of the Trustees participate in the programme.
Visit Reports
The Care Quality Commission inspection report of Mount Edgcumbe Hospice dated 5th August 2014
can be found at:
http://www.cqc.org.uk/sites/default/files/new_reports/AAAA2519.pdf
The Care Quality Commission inspection report of St Julia’s Hospice dated 14th December 2013
can be found at:
http://www.cqc.org.uk/sites/default/files/old_reports/1-109995072_St_Julias_Hospice_INS1696774278_Scheduled_04-01-2014.pdf
Statement of Assurance
Statement of assurance from the Board of Trustees
The Board of Trustees is fully committed to the delivery of
high quality services to all our patients. All Trustees are
involved in monitoring the clinical activities, by receiving
written reports as well as undertaking Provider Visits to
each unit twice a year. These visits are unannounced and
the Trustees written report is discussed by the full Board. These visits are conducted under Care Quality Commission
guidelines.
Four Clinical Trustees are active members of the Clinical
Services Committee as well as two members of the
Executive Team and two members of the Senior
Management team, which represents 50% Clinical staff and
50% Trustees.
The Board is confident that the care and treatment provided
by Cornwall Hospice Care is of high quality and cost
effective, and is committed to providing as many services as
the charity’s funds will allow.
In a time of austerity, the Charity continues to improve and
develop services to meet the needs of the patients and their
families. We depend on the generosity and continued
commitment and support of the people of Cornwall.
Mrs Elizabeth Anderson
Chair Board of Trustees
Liz Anderson thanking our Volunteers at our
Volunteer thank you event at Eden Project,
March 2015
“No matter what your role is within the hospice, together you make a wonderful team and we are
privileged to have benefitted from your work and expertise.”
Registered Charity No. 1113140
Cornwall Hospice Care is a Limited Company
Registered in England and Wales
Company No: 5660401
Registered Office: Porthpean Road
St Austell
PL26 6AB
Registered Charity No: 1113140