Transforming End of Life care in Surrey
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Our team today
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•
•
•
Nigel Harding
David Perry
Rachel Hill
Dr Fiona Bailey
• Pam Walmsley
• Shelagh Musoke
• Helen Bryant
• Liz Bennett
Chief Executive
Chairman
Director of Clinical Services
Medical Director and Consultant in
Palliative Medicine
Deputy of Clinical Services
Clinical Nurse Specialist and SBH
Community Team Lead
Ward Manager, SBH
Day Care Leader, SBH
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Sam Beare Hospice - history
• Hospital on current site built in 1927 and there has been a Sam
Beare palliative care ward since the mid 70’s
• In 2005 PCT asked for proposals for the future management of
beds
• Princess Alice planned closing the unit - Woking Hospice
proposed on-going ten bed in-patient Hospice with outreach
services and took control in 2006
• PCT support was provided but reduced over time – the deficit
was not met by fundraising
• 2008 – ‘Keep the Doors Open’ Hospices campaign to fundraise
• 2013 announcement of plans to re-locate in-patient beds in
2016
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Demographics:
Total number of
patients
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Growing need for Hospice care
• 39% increase in the number of patients admitted since 2011
• 20% increase in patients referred to our Community Teams
since 2011
• 7% increase in attendances to Day Care
• 20% increase in non-cancer referrals in the last two years
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Pressure on care services expected to
increase
• Annual mortality rate is set to rise by 2016
• People are living longer and more likely to have chronic
diseases with greater complexity
• The number of people living with cancer will increase
• By 2021 over 1 million people will be living with dementia
• Projected 135% increase in population aged >85 by 2033
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Sam Beare - facilities
We are proud of the performance of the unit and the positive
2013 report from the CQC is testament to our staff. But;
• It is integrated within Weybridge Hospital - not purpose built
and only accessed through a pharmacy and waiting room
• Public access to reception, offices and to day-care is only
possible past (often) open patient rooms
• Nurses and volunteers have to battle to maintain patient and
family privacy and dignity
• Rooms not large enough for some patient/family needs
• Patients share one bathroom as there are no en-suites
In short, it is not the ideal environment for modern palliative care.
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Planning for the future
• Against this background we conducted a detailed review and
produced a challenging Strategic Plan for the Hospices. There
were two key recommendations to:
• reshape the organisation, moving to a single, 20 bed inpatient unit
• create two centres of excellence in Day and Community
care at the Sam Beare and Woking Hospices
• A loan from Woking Borough Council enabled the Hospices to
act quickly on these recommendations
• Announced in November – public meetings held in December
2013
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Our future care services
• Hospice at home
• Community Clinical Nurse Specialists
• In-patient care
• Day care units – Community Hubs
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Oncological Outreach
Therapies
Psychological
Therapies
Counselling
Music/Art
Cafe
Light refreshments
Volunteer run
Education
delivery to HCPs
Carers Group
Medical Interventions:
- blood transfusions
- intravenous therapy
Drop In Centre
Resource / Information
Welfare Advice
Computer access
Clinical Nurse Specialist
avaialbe
Community
HUB
Therapeutic Models
Educational programmes
Complementary therapies
Art / music therapies
Respite
5 days a week
Focus to keep
patients at home
Duty Clinical Nurse Specialist
available
Outpatient
Focus work for
non-cancer
patient care
bundles
Additional Services:
Hairdresser
Bathing
Chiropody
Beauty treatments
Consultants clinics
Nurse led clinics
Therapist clinics
Base for:
Doctors
CNSs
OT
Physio
Counsellors
Admin
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Sam Beare Hospice
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Sam Beare - finances
• 2009-12 income broadly matched expenditure but costs
rising and eating into reserves
• Projected income will not cover future costs – operating loss
of £ 217k forecast for this year and a similar result expected
next year.
Costs rose significantly in 2012 due to:
• the implementation of CQC recommendations regarding the
need to bolster training, HR and educational provision
• the transfer to the Hospice of former NHS staff costs
• transfer to the Hospice of porterage and catering costs
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Sam Beare - finances
Total forecast deficit by
March 2015 = £222k
Finances stabilised in
strategic plan through relocation of in-patient beds
and creation of best in
class day-care facilities
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Sam Beare - finances
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Comparing usage
to giving:
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Sam Beare – future options
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Options
Note: There is no certainty of a lease extension at Sam Beare
We cannot continue with the 10 bed in-patient facility or
reconfigure for a 5 bed facility.
The 10 bed provision prevents us from providing the highest
standards of modern palliative care. Both are expensive options
which are not considered viable in long term.
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Preferred option
Relocate all in-patient beds and reconfigure the building to
create a centre of excellence in Day and Community care
What would need to change?
• The granting of an extended lease (due to end in 2015)
• Reconfigure building, relocating the reception
• The creation of new improved facilities, increasing capacity
for Day and Community care and support
• Permission of NHS estates and full support of CCG
• Continued strong community support
• Circa £100k capital investment
This is the preferred option as announced in November 2013
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Possible option
Relocate Sam Beare and establish a new in-patient facility and
Day and Community Care centre of excellence in the area.
What would need to happen?
• Possible granting of an extended lease (due to end in 2015)
• Identify a building in the area suitable for conversion
• Full support of CCG
• Philanthropic individuals prepared to cover purchase and
conversion costs c.£3m
• Increased, on-going community support of c.£0.5m to cover
additional costs of independent Hospice
Option being investigated and sites visited. May be viable but
certainty of short and long term funding needed.
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Next steps
Next steps:
• Negotiate and confirm lease extension beyond 2015
• Develop strategy announced in 2013 – creating a new 20 bed
in-patient facility to open in Woking in 2016 (relocating
inpatient beds from Sam Beare) and creating two centres of
excellence for Day and Community Care
• Investigate and review possible option of relocating
• Listen to and provide regular progress updates to all
stakeholders
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Transforming End of Life care in Surrey
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