QUALITY
ACCOUNT
2015/16
Our Vision
Putting local patients and families at the heart of everything we do, we will
ensure that on the journey towards the end of life, we provide the right care,
in the right place, at the right time
Our Values:
•
Care – We will provide 1st class care, delivered by competent people who
put the patient at the heart of all we do
Compassion – We will treat everyone with respect, dignity and empathy
Collaboration – We will work with others to ensure that patients and
families receive the best end of life care possible
Charity – We will provide care free of charge to patients and families and
will connect with our local communities so that they continue to finance
our present and our future
Celebration – We will celebrate the abilities of the people we care for,
however limited they may be. When people are bereaved, we will support
them to celebrate the lives of the people they have lost
St John’s Hospice
Built by the people, for the people
1
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation
registered in England with charity number 1157030
Part 1
Chief Executive’s Statement
It gives me great pleasure to present this Quality Account for St John’s Hospice. In
this account our aim is to show how the Hospice measures quality, involves patients,
carers and staff and strives to always look for areas where we can improve our care.
A Quality Account is an annual report to the public from providers of NHS healthcare
about the quality of services they deliver. It is important to note that St John’s
Hospice only receives around 30% of its funding from the NHS; the rest (£2.7million)
is donated by the local community. The majority of services described in this
document are funded by charitable donation rather than by the NHS.
Quality sits at the centre of all that the Hospice does. Our vision is that everyone in
our catchment area of South Lakeland, parts of North Yorkshire and all of North
Lancashire with any life-limiting condition will have high quality care and support at
the end of their life in the right place, at the right time.
We asked patients, families, volunteers and staff to sum up in one word what St
John’s means to them. Their key words can be seen here:
2
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation
registered in England with charity number 1157030
Our Corporate and Clinical Governance structures ensure that we have both the
systems and processes in place to maintain a viable and responsible business, whilst
ensuring that our services are of the highest quality and meet the aspirations of our
vision. Our services are subject to unannounced inspections at any time.
On the 13th February 2014, the Care Quality Commission (CQC) conducted an
unannounced inspection of the Hospice. A CQC Inspector and an “expert inspector”
specialising in Governance attended. They spent a full day speaking to patients,
families and staff and scrutinising records and documentation. The Hospice was
judged to be fully compliant in all areas inspected. They said:
“We found there were good systems and processes in place to monitor the quality
of the service being provided. Staff told us this was underpinned by an open
reporting culture and strong leadership.”
As I write this account, we await inspection under the new CQC regime for Hospice
services. Responsibility for inspecting Hospices will move from the NHS to the Adult
Social Care Directorate.
I am responsible for the preparation of this report and its contents. To the best of my
knowledge, the information contained in this Quality Account is accurate and a fair
representation of the quality of healthcare services provided by our Hospice.
Sue McGraw
Chief Executive
30th March 2015
3
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation
registered in England with charity number 1157030
Part 2
Priorities for Improvement 2015/16
The priorities for improvement we have identified for 2015/16 are set out below.
Our focus for the year ahead will be on reaching more people and increasing our
impact. Our priorities have been developed in conjunction with feedback from our
VOICE group (Valued Opinions in Care Excellence.) The VOICE group is made up of
patients, family members and Volunteers, all of whom have had recent experience of
Hospice services. In addition, the Quality Account has been to our Staff Forum for
consultation. We have expressed our priorities in terms of the three domains of
quality:
• Patient safety
• Clinical effectiveness
• Patient experience
Priority 1 –Patient Experience
Review the Provision of Spiritual Care and Equality and Inclusion
How was this priority identified?
St John’s Hospice was founded almost 30 years ago. Whilst our Christian heritage is
treasured by some of our supporters, this approach no longer fully reflects the
demographics of the community we serve. Indeed, our history and heritage is often a
barrier for certain sectors of our community. The vast majority of our patients
identify themselves as having no faith or to be of a non-practicing Christian
background.
The provision of spiritual care for patients and families has been discussed at Board
level for a number of years. Many hospices still employ a Hospice Chaplain. Last
year the Board of Trustees made the decision to move away from the Chaplaincy
model. A temporary post, “Spiritual Care Coordinator” was piloted for 6 months.
The role of the Spiritual Care Coordinator was to reach out into community and faith
groups to establish links with volunteers who could be called upon when needed.
This model has proved to be so effective, the Board of Trustees made the post
substantive in December 2014.
4
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation
registered in England with charity number 1157030
To continue the development of spiritual care provision, in April 2015 the CEO
commissioned a “visual audit” of the Hospice building with regards to Equality &
inclusion. This audit was carried out by the Head of Equality & Inclusion from the
Lancashire and Midlands Commissioning Support unit.
In summary the
recommendations were that:
1.
To develop a more inclusive atmosphere, we should consider moving the cross
on the outer wall of the Chapel to another less prominent position.
2.
Identify a suitable location for a multi-faith room/space for quiet reflection.
The findings of the report were discussed on the 28th April 2015 with the hospice
VOICE group. The group suggested a number of suitable locations. One suggestion
was to develop a garden room in the central courtyard of the Hospice, subject to
grant funding. Over the next 12 months we will work with volunteers from
demographically significant faith groups and the VOICE group to identify a suitable,
inclusive space for quiet reflection.
How will progress be monitored and reported?
•
•
•
The VOICE group will monitor the development of this project
Progress will be reported via the Care, Quality & Services Sub-Committee of
the Board
Feedback and consultation will be undertaken with key faith groups from
our local communities
Priority 2 – Clinical Effectiveness, Patient Experience & Patient
Safety
Develop a Dementia Friendly Ward Environment
How was this priority identified?
Dementia care is an increasingly important strategic consideration for palliative and end
of life care providers. The anticipated changes in population size, age and related
morbidity and mortality indicate dementia will call for increasing levels of health and
social care, including end of life care. Dementia is now one of the biggest global public
health challenges facing our generation. Over 35 million people worldwide are
currently living with a diagnosis of dementia. This is projected to double by 2030 and
more than triple by 2050.
5
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation
registered in England with charity number 1157030
Dementia is now acknowledged as a life limiting condition with most dementias being
progressive in nature and no curative treatment to date. If St John’s Hospice is to
respond to the needs of its community in coming years, the infrastructure of the
building and the skills of our staff must be developed to meet this need.
In March 2015 the Hospice VOICE group was asked to conduct a review of the ward and
its associated areas. Many of their comments and observations mirror guidance from
The King’s Fund on developing dementia-friendly in-patient units “Enhancing the
Healing Environment” for example, the group would like a complete review of signage
on the ward. They considered current signage to be confusing, sometimes missing and
out of date. The group suggested an update of the reception/nurses station at the
centre of the ward, again mirroring The King’s Fund recommendations regarding best
practice. It is our ambition to apply for grant funding to update the ward over the next
12 months.
Whilst there is no doubt about the skills and level of care our staff provide for patients
at the end of life, we do feel that more in depth skills training in dementia care would
enhance our practice. Our Education Team are working in partnership with the
University of Cumbria to develop an accredited Dementia Skills module of a palliative
care certificate. It is our intention over the next 12 months to enhance the training of
all our staff in this area and to provide training to health and social care colleagues in
the community.
The St. James’s Place Charitable Foundation is currently inviting hospices to bid via a
grant programme to fund projects for hospice-enabled dementia care. St John’s
Hospice has made a bid to employ a dementia nurse trained in the use of the Namaste
model. The Namaste Care programme was developed by Professor Joyce Simard in the
USA in 2003. ‘Namaste’ is the Indian greeting meaning ‘to honour the spirit within’. The
care programme was developed to meet the needs of people with advanced dementia
for human contact, sensory stimulation and meaningful activity. Namaste Care seeks to
engage people with advanced dementia through sensory input, comfort and pleasure.
Namaste combines compassionate nursing care with music, therapeutic touch, colour,
food treats and scents. Families are supported to acknowledge the progression of
dementia in the positive context of seeking to provide quality of life. We will know if
our bid has been successful in June 2015.
How will progress be monitored and reported?
•
The VOICE group will be actively involved in monitoring physical improvements
on the ward.
6
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation
registered in England with charity number 1157030
•
•
The Care, Quality & Services Sub-committee of the Board will receive regular
update reports
Progress will be reported quarterly to the full Board of Trustees
Priority 3 – Effectiveness & Patient Experience
Conduct a Review of Engagement and Consultation Processes
and Procedures.
How was this priority identified?
In the next 12 months we will review all our engagement and consultation channels.
This will include: the work of the VOICE group, patient and family surveys, incident
reports, comments, compliments and complaints, the use of suggestions boxes, Staff
Forum, feedback received on social media and more traditional channels. We will
work with Hospice UK, the umbrella organisation for hospices to ensure that our
engagement and consultation processes are at the leading edge of good practice.
How will progress be monitored and reported?
•
•
•
•
Review the current consultation and engagement strategies
Develop a task and finish group comprising of Trustees and key staff to
consider new methods gathering feedback
The Care, Quality & Services Sub-committee will receive regular update reports
Progress will be reported quarterly to the full Board of Trustees
Priority 4 – Effectiveness
Develop Volunteer-led Services to Reach more People and
Increase Impact
How was this priority identified?
Volunteers have been at the heart of service delivery in the Hospice for 30 years. The
rise of regulatory requirements and health & safety culture has meant that we have
restricted the roles we may have traditionally allowed volunteers to fulfil. In the next
12 months we will pilot a number of volunteer projects that will allow us to test how
far volunteers may still be involved in some aspects of clinical and social care. For
7
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation
registered in England with charity number 1157030
example, we have received grant funding to fund a post that will focus on the use of
volunteers in traditionally clinical roles on the ward. We have received funding from
The Prime Ministers Challenge Fund to develop a network of “Hospice Neighbours”;
their role will be to support people who place large amounts of demand on the wider
health and social system.
We will review the provision of Day Hospice care. Volunteers are actively involved in
the day-to-day running of this service, it is our intention over the next 12 months to
establish a “positive living” drop-in programme that will be delivered, not only at the
Hospice, but also in community settings.
How will progress be monitored and reported?
• Project managers will report progress to the Care, Quality & Service Subcommittee
• Progress will be reported quarterly to the full Board of Trustees
Review of 2013/14 Priorities for Improvement
Develop a Workforce that is Fit for the Future
Review
Working in consultation with staff, a complete review of shifts, working patterns and
ward management was undertaken in the previous year. The aim of the review was
to ensure that patients and families received consistent and safe care. All staff now
work on a rotating shift pattern to ensure that the skills of our team are shared and
up to date.
A complete review of competencies was undertaken and is still ongoing. Induction
for care staff has been updated and extended and in the next 12 months all new care
staff will complete the “Care Certificate” as part of their induction and probationary
period.
Mandatory training for the Clinical Team has been reviewed. Developments in our
Education Team mean that we are now able to offer a mix of on-line and face-to-face
training, some of which will be accredited by the University of Cumbria.
8
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation
registered in England with charity number 1157030
Conduct a Food & Nutrition Review across the Hospice
Review
The demise of the Liverpool Care Pathway in
2013 prompted the Hospice to review the
provision of food and hydration to patients
at the end of life. The CEO commissioned an
audit which included surveys of patients and
families’ views and considered the skills of
our catering team.
The Head of Nursing & Quality has commissioned support from University Hospitals
Morecambe Bay Trust (UHMBT) Dietetics Team. They will visit the Hospice once a
month to provide help and advice to the Catering Team. In addition the Head of the
Catering & Hospitality School at Kendal College is advising the Catering Team with
regards to menu planning and nutritional content.
We obtained a grant of £5,000 from the Foundation of Nursing Studies (FoNS) to
develop a new role – Nutritional Support Worker. The purpose of this role is to
highlight the importance of meeting patients’ likes and nutritional needs on the
ward.
Our patient & family surveys still indicate that the quality of our food is very good
however, the Hospice is determined to ensure that our provision of food and
nutrition is supported by a strong evidence base and keeps abreast of new
techniques and guidance. Our volunteers continue to develop our Hospice
allotment. Between May and October, much of the fruit and vegetables we require
is grown on-site. The volunteer gardeners will be actively encouraged to meet and
work with our partners from the dietetics team at UHMBT and from Kendal College.
9
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation
registered in England with charity number 1157030
Adoption of an Electronic Record System to Ensure Patients
Receive Safe, Effective Patient Care.
Review
EMIS Web was chosen as the preferred electronic patient record system. EMIS is used
by all our GP Practices and the majority of the Community Nursing Teams. It was felt
that the adoption of the same system would enable us to safely and effectively admit,
treat and discharge patients.
The implementation of the system has taken 12 months. Monthly project
management meetings have taken place with representatives from the Hospice,
UHMBT, the Locality GP with responsibility for I.T. and with other healthcare
colleagues as required. Whilst the process has taken longer than anticipated, we are
pleased to report that the Hospice went “live” on EMIS on 27th April 2015. Early
indications show that our thorough project management and training provision has
been of great benefit to the team who seem to have made such a major transition
smoothly.
Part 2 (Continued)
Statements of Assurance from the Board
Quality Accounts have a series of statements that MUST be included. Many of these
statements do not apply to St John’s Hospice. Explanations of these statements are
given where appropriate and are prefaced by the words: “MANDATORY
STATEMENT”.
During 2014/15, St John’s Hospice provided the following
services:
•
In Patient Unit
•
Hospice at Home Service
•
Day Hospice
•
•
•
Family Support and Bereavement Service
COPD/MND/Parkinsons Support Groups
Education and Training – Including 6 Steps to Success programme with Care
Homes and domiciliary agencies.
Education and Training – Including Lancaster University GP trainees, GPSTRs
from the Lancaster University Medical School, Nurses and Occupational
Therapists from UCLAN and University of Cumbria
•
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation registered in England with
charity number 1157030
10
•
•
Out Patient Clinics
Physiotherapy, Occupational Therapy, Social Work and Lymphoedema Services
Charitable donations support 70% of this work, the remaining 30% comes from the
NHS.
MANDATORY STATEMENT – St John’s Hospice has reviewed all the data available to
them on the quality of care in all these NHS services.
Participation in Clinical Audits
The following are examples of audits (both clinical and non-clinical) conducted within
the Hospice in 2014/15:
• Nursing Uniform
• Hand Hygiene
• Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) & Preferred
Priorities of Care (PPC) documentation
• Spiritual Care
• Controlled Drugs Accountable Officer
• Information Governance Compliance
• Record keeping
• Education Audit
We were also active participants in the regional Lidocaine audit for the North West
Palliative Care Audit Group.
Some positive outcomes have been achieved from this year’s audit activity; headline
themes being:
• Controlled Drugs – progress has been made as initial audits in 2013-14
focussed on physical storage and improved management of the Controlled
Drug keys/fob locks. This year we have been able to drill down on quality
issues such as improved monitoring systems ensuring appropriate signatures
are exact and up to date.
• Record Keeping – audit activity in this area highlighted the need for improved
record keeping. This applied to both clinical and non-clinical information such
as spiritual care preferences. This has led to the introduction of record
keeping within our annual Clinical Mandatory Training Programme and will be
further supported by the introduction of electronic clinical record keeping
EMIS which has been implemented in May 2015.
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation registered in England with
charity number 1157030
11
• Education – a Resource Room has been identified and is available to Medical,
Nursing & Allied Health Students to access journals and use our available
workspace to access e-resources and internet/intranet.
Research
MANDATORY STATEMENT - The number of patients receiving NHS services provided
or sub- contracted by St John’s Hospice in 2014/15 that were recruited during that
period to participate in research approved by a research ethics committee was
NONE.
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation registered in England with
charity number 1157030
12
Use of the CQUIN Payment Framework
The Hospice at Home Hub was asked to work on the CQUIN framework below, results are
indicated, all goals were achieved.
Goal
Number
1
2
3
4
Goal Name
Description of
Goal
Goal
weighting
(% of
CQUIN
scheme
available)
Expected
financial
value of
Goal (£)
Quality
H@H Hub
Domain
Response
(Safety,
Effectiveness
Patient
Experience
or
Innovation)
Friend and
Family Test
Develop and
pilot family &
carer survey in
year
50.00%
£1,440.50
Patient
Experience
Completed,
although
this will
continue.
£0.00
0
N/A
£1,440.50
Effectiveness
Completed.
£0.00
Patient
Experience
N/A
Locally develop
NHS Safety
implementation 0.00%
Thermometer of safety tools
applicable to
the service
All staff
Dementia
undertake
50.00%
Dementia
awareness
training
Training to
VTE
identify, assess 0.00%
and manage
treatment of
VTE, where
appropriate in
year
Total
100.00%
MANDATORY STATEMENT - £2881.00 of St John’s Hospice NHS income in 2014/15 was conditional on
achieving CQUIN targets as outlined above. All targets were achieved.
13
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation registered in England with
charity number 1157030
Statement from the Care Quality Commission (CQC)
St John’s Hospice is required to register with the CQC; we are registered to carry out the
following regulated activities:
Treatment of disease, disorder or injury
Diagnostic and screening processes
Transport services, triage and medical advice provided remotely
St John’s Hospice has the following conditions on registration:
Only treat people over 18 years old
Only accommodate a maximum of 20 in-patients
The CQC has not taken any enforcement action against St John’s Hospice during 2014/15.
th
Our most recent CQC inspection took place on 13 February 2014. Two inspectors made an
unannounced visit to the Hospice. The Inspectors’ overview of the Inspection was as follows:
“We spoke with a range of people about the hospice. They included the registered manager,
staff members, volunteers, patients, relatives and visitors. We also asked for the views of
external agencies in order to gain a balanced overview of what people experienced using St
John’s Hospice. We spoke with patients and relatives. They told us they could express their
views and were involved in making decisions about their care. They told us they felt listened
to when discussing their care needs. Staff confirmed to us they also involved relatives, where
possible to ensure people received the right care and support. We spent time in all areas of
the hospice, including the day centre and in-patient unit. This helped us to observe the daily
routines and gain an insight into how people's care and support was being managed. Staff
treated people with respect and ensured their privacy when supporting them. They provided
support or attention as people requested it. We spoke with people about the care and
support they received. They said they were happy with the care and support being provided.
We looked at how the service was being staffed and reviewed staff training and supervision.
We saw there were sufficient staff on each shift with a range of skills and experience. Staff
told us they felt supported, had regular meetings with their manager, and their training was
kept up to date. We found there were good systems and processes in place to monitor the
quality of the service being provided. Staff told us they felt this was underpinned by an open
reporting culture and strong leadership.”
Areas inspected were:





Treating people with respect and involving them in their care
Providing care, treatment & support that meets people's needs
Caring for people safely & protecting them from harm
Staffing
Management
All areas inspected fully met CQC standards.
14
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation registered in England with
charity number 1157030
Data Quality
MANDATORY STATEMENT - St John’s Hospice did not submit records during 2014/15
to the Secondary Users Service for inclusion in the Hospital Episode Statistics which are
included in the latest published data.
However, St John’s Hospice does submit data to the Minimum Data Set (MDS) for
Specialist Palliative Care services collected by the National Council for Palliative Care
on an annual basis, with the aim of providing an accurate picture of Hospice and
Specialist Palliative Care service activity. Data taken from the MDS is reported in
section 3, Review of quality Performance.
Information Governance Toolkit
St John’s Hospice Information Governance Assessment Report overall score for 2014/15
was 85%. This has been audited and verified by the Information Governance Team at
the Health & Social Care Information Centre.
Clinical Coding Error
MANDATORY STATEMENT – St John’s Hospice was not subject to the payment by
results clinical coding audit during 2014/15
15
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation registered in England with
charity number 1157030
Part 3
Review of Quality Performance
In this section, we have chosen to provide data benchmarking St John’s Hospice with
figures from the National Council for Palliative Care Minimum Data Set, (MDS.) The
MDS is the only national benchmarking tool for Hospices.
In Patient Unit
2014/15
2013/14
2012/13
Total number of
patients
278
295
293
Number of new
patients
235
258
259
% Occupancy
75%
77%
74%
Location after end of
stay
(N.B. Figures do not
total because some
patients were admitted
more than once.)
173-Deaths
159-Deaths
161-Deaths
139-Home
152-Home
169-Home
8-Care Home
16-Care Home
7-Care Home
3-Acute Hospital
3-Acute Hospital
4-Acute Hospital
20-Other
22-Other
9-Other
14
13.4
15.4
2014/15
2013/14
2012/13
Average length of stay
(in days)
Hospice at Home/CNS
Total number of
patients
Total number of visits
face to face
527
541
315
13,572
12,327
4,902
Total number of
telephone calls
12,756
10,302
4,722
92%
85%
92%
61.5
43
25.9
% of people who died at
home
Average length of care
(in days)
16
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation registered in England with
charity number 1157030
Day Hospice
2014/15
2013/14
2012/13
Total number of
patients
163
147
140
% new patients
60%
66%
69%
Average period of
attendance (in days)
73.5
80.5
85
2014/15
2013/14
2012/13
Total service users
502
420
456
Number of whom
formal support ended
423
344
391
Average length of
support (in days)
67.3
45.4
47
Family Support and
Bereavement Service
Feedback from Staff
An annual staff satisfaction survey is conducted. The top three statements that staff
agreed with were:
If a friend or relative needed treatment, I would be happy with the standard
of care provided by the Hospice – 96%
I enjoy the work I do – 94%
I am proud to work for St John’s Hospice – 96%
17
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation registered in England with
charity number 1157030
Feedback from Patients, Families and Carers
Feedback from patients, families and carers is one of the most important ways for us
to understand and improve the services we provide.
We often receive comments and compliments by letter or email, here is a montage of
some of them:
We never forget that the sign above the door here reads “built by the people for
the people”. Putting patients and families at the heart of what we do is
fundamental for the Hospice.
We have very few complaints – formal or informal. However, in 2014/15 one family
complained about the attitude of a member of our night staff team. We responded to this
by conducting a thorough investigation, providing additional skills training for the team
member, changing shift patterns to rotate people through days and nights. The person
who made the complaint was invited to join our VOICE group and we are pleased to report
that she has now become a member.
18
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation registered in England with
charity number 1157030
Surveys
Our volunteers conduct patient surveys on the Ward. This year, comments have
been almost 100% positive.
As part of our contract with the CCG, we are required to survey bereaved families
for our Hospice at Home service. Again, responses have been overwhelmingly
positive.
Complaints 2014/15
Complaints are all monitored by the relevant member of Senior Management
Team, clinical complaints are discussed at the Care , Quality & Services
Committee and are reported to the full Board of Trustees.
Complaints
Number
Total number received
2
Total number of complaints upheld in full
2
Total number of complaints upheld in part
0
Total number of complaints not upheld
0
Opportunities to give Feedback on this Quality Account
We welcome feedback on our Quality Account. If you have any comments, please email:
Sue.mcgraw@sjhospice.org.uk
Or write to:
Sue McGraw
CEO
St John’s Hospice
Slyne Rd
Lancaster
LA2 6ST
19
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation registered in England with
charity number 1157030
Annex
Comments from Healthwatch North Lancashire
Healthwatch Lancashire were unable to provide a comment on our Quality Account
this year.
Comments from North Lancashire CCG
“I think the report is an excellent reflection of the level of consideration you have
given to leading and developing the Hospice and the staff are to be commended on
their hard work and commitment.”
Commissioning Manager, Lancashire North CCG
20
St. John’s Hospice North Lancashire & South Lakes is a Charitable Incorporated Organisation registered in England with
charity number 1157030