ASHGATE HOSPICE
SERVICES & REFERRAL INFORMATION
INTRODUCTION
Ashgate Hospice provides specialist palliative care and support to patients with a life-limiting
illness and their families/carers. The hospice provides care for adults who live in and/or who
have a GP based in North Derbyshire – the area previously covered by the Chesterfield, North
East Derbyshire and High Peak Primary Care Trusts.
The hospice opened in 1988 and since that time the services provided have been extended
considerably. Last year over 1000 patients and families received care and support in their own
home and over 350 patients were admitted to our In-Patient Unit.
The multi-disciplinary team consists of specialist doctors (led by Consultants in Palliative
Medicine), nurses, pharmacists, physiotherapists, occupational therapists, social workers,
chaplain, lymphoedema nurses, psychologists and the family support team. They have
undergone additional training and education and have appropriate experience to enable them to
provide this specialist service. Care and support is provided in a variety of settings, including:
Community – home, nursing & residential home, community hospitals
In-Patient Unit
Day Centre
Hospital – Chesterfield Royal
Out-patients
Although historically known for the support it gives to patients with cancer, 15% of our patients
have other life-limiting illness. We are very keen to increase this aspect of its work and links
have been made with specialists in other fields. For example, the British Heart Foundation
nurses hold an out-patient’s clinic at the hospice and monthly MDT’s. We also provide support
to Blythe House Day Hospice in Chapel en le Frith, including the Consultant in Palliative
Medicine, Physiotherapists, Occupational Therapists and Social Workers.
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If you have not had an opportunity to visit the hospice we would be very happy to show you
round and discuss the services we provide in more detail. We would also be happy to discuss
how you think we could develop our services and work together in the future.
Team managers include:
Mrs Kathy Hollyer – Chief Executive
Dr Sarah Parnacott – Consultant in Palliative Medicine
Dr David Brooks – Consultant in Palliative Medicine
Mrs Margaret Borrell – Head of Nursing Services (Hospice)
Mr Tony Reid – Head of Nursing Services (Community & Hospital)
Ms Claire Blakey – Macmillan Community and Hospital team manager
Miss Emma Wright – Therapy Services Manager
Mrs Lynda Parrish – Lymphoedema Services Manager
Mr Paul Scrogie – Social Work Team Manager
Mrs Tracey Brailsford – Family Support Co-ordinator
Mrs Sue Crabtree – Manager In-patient unit and day centre.
Mrs Jane Irani – Professional Development Adviser
Attached is some information on our services. Further information is available from the hospice
on 01246 568801 or our more detailed information leaflets.
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COMMUNITY SERVICES
The hospice provides a variety of services to patients and their families/carers in their own
home (including residential or nursing home). The team includes the Community Macmillan
Clinical Nurse Specialists, Home Care Support Workers, Hospital specialist palliative care team,
Physiotherapists, Occupational Therapists, Lymphoedema management, Social Workers and
Family Support Team. Domiciliary visits and/or out-patient appointments by a member of the
medical team may also be arranged.
Community Clinical Nurse Specialists (Macmillan Nurses)
Introduction
This service is provided by Community Clinical Nurse Specialists (Macmillan Nurses) who have
undergone specialist education and training and have appropriate experience to enable them to
provide a specialist service.
The service provides specialist advice and support to promote the highest quality of life
attainable for individuals with cancer and other life limiting illnesses within their family/carer
setting.
Through specialist advice and education the service also provides support to the Primary Health
Care Team and other professional colleagues including those in community hospitals and
nursing homes.
The Macmillan Nurses each have links with specific GP practices but working as a team they
share workload when required to ensure continuity of care.
Service Availability
This service is available Monday to Friday 9am to 5pm. Appointments outside these hours may
be negotiated with individual team members.
Out of hours advice is provided by the on call Specialist Registrar or Consultant in Palliative
Medicine.
Referrals
A referral to the Macmillan Nursing Service can be made by anyone. However, the team will
consult the Primary Healthcare Team and assess the level of specialist support required.
Referrals are accepted by phone, fax or letter and following prioritisation, the Macmillan Nurse
will make contact on the same day for urgent referrals and within 2 working days for all other
referrals. We also:
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Inform the primary health care team of the Community Macmillan Nurse Specialists
involvement following the initial referral.
Undertake a specialist assessment with the patient in order to manage identified
problems within 5 days of contact.
Following the assessment and discussion with the patient and/or carer and referrer and
primary health care team agree on continued plan of care and monitoring
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Home Care Support Team
Introduction
The service aims to provide support and respite at home in order to promote the highest quality
of life attainable for individuals with Cancer and other life limiting illnesses.
Service Availability
This service is available Monday to Friday, 8.30am to 5pm. Crisis prevention support is
(dependant on resources) available outside these hours on request from a District Nurse or
Macmillan Nurse and is organised by the Hospice at Home Co-ordinator.
Referrals
Referrals are normally made by the Specialist Palliative Care Team. The Primary Health Care
Team may also refer direct to the service, however, the Head of Nursing Services (Community
& Hospital) will assess the appropriateness of the referral before the patient is accepted.
The Home Care Support Team work with the Primary Healthcare Team, statutory services,
healthcare agencies and other voluntary organisations to assist patients to be adequately cared
for at home, when this is their wish.
The Service includes:
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Providing help to patients and their families/carers in their own homes
Providing support and respite for families/carers
Helping prevent crisis admission to hospice and hospital
Assisting discharge home from hospice or hospital
IN-PATIENT UNIT
Introduction
The In-Patient Unit provides specialist palliative care, treatment and support for adults, who
have a life-limiting illness. Patients and their families have access to all the multi-disciplinary
team, including the specialist doctors (led by Consultants in Palliative Medicine), nurses,
physiotherapists, occupational therapists, social workers, chaplain, lymphoedema nurses and
the family support team.
Patients may be referred for:
a) Symptom control - assessment and management
b) Terminal care
Referrals
Referrals to the in-patient unit may be made by the patient’s General Practitioner or Consultant
(or by any health professional on their behalf).
Referral to the In Patient Unit may be made in writing or by telephone to any member of the
admissions team. The team consists of the Head of Nursing Services (Hospice), In-Patient Unit
Manager and Consultants in Palliative Medicine.
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In the absence of the admissions team the referral is taken by a senior nurse on the In-Patient
Unit and passed on to a member of the admissions team as soon as possible.
Referral for admission on Bank Holidays and weekends are relayed to the Specialist Registrar
on call for discussion with the Consultant in Palliative Medicine. Patients are not routinely
admitted during the evening/night.
DAY CENTRE
Introduction
The Day Centre provides specialist palliative care and support to patients with life-limiting
illnesses. Patients attending Day Centre and their families/carers may also access telephone
support and advice as necessary. The Day Centre is able to accept 16 patients per day.
Service Availability
The Day Centre is open Tuesday to Friday, with patients normally attending for one session per
week.
Referrals
Any member of the Specialist Palliative Care Team, GP or District Nurse may make referrals to
the Day Centre. Referrals are accepted Monday to Friday, 9am to 4.30pm.
Referrals are discussed by the Day Centre Sister and Consultant and places offered, initially for
a period of 6 weeks.
The Day Centre provides the following services:
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Nursing care and medical assessment
Physiotherapy and Occupational Therapy
Diversional Therapies
Practical support and advice, e.g. benefits advice
Psychological and emotional support
Spiritual support
Some medical treatments
Access to equipment needed to help at home
Dietary advice
OUT-PATIENTS
Introduction
Out-patient appointments are offered by most members of the multi-disciplinary team.
Service Availability
Appointments are available during normal working hours.
Referrals
Referrals for out-patient appointments should be made direct with the member of the multidisciplinary team required or with the medical secretaries
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HOSPITAL PALLIATIVE CARE TEAM
Introduction
A team of four clinical nurse specialists employed by Ashgate Hospice are based at Chesterfield
Royal Hospital. They work closely with the Consultant and Specialist Registrar in Palliative
Medicine.
The team provide specialist advice and support to patients and their carers and endeavour to
bring the specialist care provided by the hospice, into the acute setting, thus allowing people
with life limiting illnesses to have the highest quality of care available, irrespective of
environment.
Service Availability
This service is available Monday to Friday during normal working hours.
Wards are informed of the out of hour’s service that is available via switchboard.
Referrals
Referrals are accepted from the ward medical teams, or through Ashgate services. The majority
of patients are seen on the day of referral for specialist assessment of their needs. The team will
also accept referrals from the GP when their patients are admitted.
The team is actively involved in discharge planning to support patient choice and enable people
to return home. Working alongside the Consultant and Specialist Registrar, a Palliative Care
Outpatient clinic is held at the Royal on a weekly basis, thus allowing more people to stay in
their own homes, knowing they have a regular specialist follow up appointment.
In addition, through specialist advice and education, the team provide teaching sessions for staff
on both a formal and informal level and work closely with the Royal in end of life matters,
developing the Last Days of Life Pathway used at The Royal.
The team visits the Emergency Management Unit, each morning to see if they have any
patients with specialist palliative care needs. This may involve arranging urgent transfer to
Sheffield Hospitals, or for transfer to Ashgate.
PALLIATIVE MEDICINE
Introduction
The medical team includes two Consultants in Palliative Medicine, supported by Specialist
Registrars, F1 and F2 Doctors and Clinical Assistants (GPs with a special interest in palliative
medicine).
The team provides Specialist palliative medical support and consultancy to the service and
wider healthcare community across all care settings.
Service Availability
The consultants and doctors are contactable during normal working hours through the hospice.
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The team is part of the Sheffield on-call rotation, ensuring that specialist doctors are on call outof-hours.
Out of hours contact with the on call specialist registrar or consultant can be made through the
Chesterfield Royal switchboard or via the hospice.
Referrals
The medical team sees patients and their families/carers in all settings, as appropriate, including
community, in-patient unit, day centre and hospital. The doctors also provide support and advice
to members of the primary care team.
PHYSIOTHERAPY
Introduction
This service is provided by the Therapy Services Manager, Specialist Palliative Care
Physiotherapists and Technical Instructors.
The service aims to provide symptom management and rehabilitation utilising a range of
treatments, focusing on improving/ maintaining the patient’s quality of life.
Service Availability
The service is available Monday to Friday during normal office hours.
Appointments outside these hours may be negotiated with the therapist. Patients may be seen
in their own home, in the Day Centre, in the Inpatient Unit, as out-patients or at Blythe House
Day Hospice.
Referrals
Any member of the Specialist Palliative Care Team can make a referral to the physiotherapy
service. Referrals from the Primary Health Care Team, hospital teams and social services may
also be made direct to the service. However, the Physiotherapist must agree that there is a
need for the specialist service.
The service provides assessment, treatment planning, implementation including use of
acupuncture and evaluation on an individual patient basis. A patient may be referred to the
physiotherapist for assistance with a variety of problems such as:
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Poor mobility
Poor limb function
Pain
Anxiety affecting mobility/breathlessness
Breathlessness
Fatigue management
Simple Oedema
OCCUPATIONAL THERAPY
Introduction
This service is provided by the Therapy Services Manager, Specialist Palliative Care
Occupational Therapists and Technical Instructors, and the Therapy Drivers.
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The service aims to promote patient independence for as long as possible, focusing on
improving/ maintaining the patient’s quality of life.
Service Availability
The service is available Monday to Friday during normal office hours. Appointments outside
these hours may be negotiated with the therapist. Patients may be seen in their own home, in
the Day Centre, in the Inpatient Unit, or at Blythe House Day Hospice.
Referrals
A referral to the occupational therapy service can be made by any member of the Specialist
Palliative Care Team. Referrals from the Primary Health Care Team, hospital team and social
services may also be made direct to the service.
The Occupational Therapists provide advice for patients, family and professional carers on the
appropriateness of equipment a patient may need to maintain their independence and quality of
life.
This may include equipment:
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to assist with activities of daily living
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for the relief of pressure
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for safe moving and handling
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wheelchairs
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managing fatigue
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managing breathlessness.
In certain situations where homes meet specific criteria Ashgate Hospice are able to assess and
arrange for the installation of stairlifts.
MACMILLAN LYMPHOEDEMA TEAM
Introduction
The Macmillan Lymphoedema Service provides treatment, support and care to patients
suffering from either primary or secondary lymphoedema. Patients do not have to be suffering
from a life-limiting illness to access the service.
The service is provided by the Consultant in Palliative Medicine, specialist lymphoedema nurses
and a lymphoedema healthcare technician.
Service Availability
The service is available Monday to Friday during normal office hours. Patients may be seen as
out-patients at Ashgate Hospice or Blythe House Hospice, in their own home, in the Day Centre,
or in the In-patient Unit.
Referrals
A referral to the Macmillan Lymphoedema Service can be made by any member of the
Specialist Palliative Care Team. Referrals from the Primary Healthcare Team may also be made
direct to the service.
The usual response times are:
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Cancer Palliative care - 2-4 working days (Hospice In-Patient Unit 1 working day)
Cancer Lymphoedema - 2 weeks
Non Cancer Lymphoedema - 12-16 weeks
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The Lymphoedema service provision includes:
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Initial medical and specialist nurse assessment, treatment planning and education.
Patient review
Manual Lymphatic drainage
Decongestive lymphatic therapy
Garment supply and fitting
The Team provide support, training and advice to:
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Other professionals within the Specialist Palliative Care Team
Primary healthcare professionals
Hospital healthcare professionals
SOCIAL WORK
Introduction
The Social Work Service/Palliative Care Assessment Team is provided by social workers/care
managers who have received additional education and training in palliative care issues.
The role of the team is to promote the rights of patients and their carers by providing advice on
services available to them, which includes advice on maximising people’s financial
circumstances. The Social Work Team also provides emotional support for patients and carers.
Service Availability
The service is available Monday to Friday during normal office hours. Appointments outside
these hours may be negotiated with the individual team members. Patients and carers may be
seen in their own home, in the Day Centre, as out-patients or in the In-patient Unit.
The Social Work Team work within the following timescales;
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To make contact within 24 hours of receiving the referral, and
To have commenced assessment of a patient’s needs within 5 working days
Referrals
A referral to the social work service can be made by any member of the Specialist Palliative
Care Team. Referrals from the Primary Healthcare Team may also be made direct to the
service. The social workers must agree that there is a need for the specialist service before the
patient is accepted.
Referrals are received by phone, fax or letter (and incorporate the new “Single Assessment
Process” and subsequent new documentation).
The social workers work within the Derbyshire Social Services’ Framework for access to and
provision of social services and benefits. They have available, for patient and professional use;
a range of information leaflets on the statutory and voluntary services/ benefits available in
North Derbyshire and High Peak and Dales.
Services include:
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Offering/conducting full needs assessments to include collecting assessments from
other professionals involved such as Macmillan Nurses, Consultants etc.
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Advising patients, family/carers and professionals, on the appropriateness and
availability of social service support for patients who are to be cared for in the
community. They co-ordinate mainstream discharge packages, working with and
referring patients for care management as appropriate.
The social worker will liaise with other agencies in order to obtain the services required
to support the patient in their own home.
For patients who are unable to return home because of their personal circumstances,
but do not require continuous specialist inpatient care, the social worker will work with
the patient and family/carer in order to find suitable accommodation in a residential or
nursing home.
Advising on the benefits available to patients and family/carers.
MACMILLAN FAMILY SUPPORT TEAM
Introduction
The service is provided by a Macmillan Family Support Team Coordinator, Macmillan Social
Worker, Hospice Chaplain, Clinical Psychologist, counselling students, volunteer counsellors
and trained family support volunteers.
The team provides assessment and emotional and psychological support for the family, friends
and carers of people who have died or have a life limiting illness and are known to a Specialist
Palliative Care Team. The Family Support Team also supports the children of patients.
Service Availability
The service is available Monday to Friday during normal office hours. Appointments outside
these hours may be negotiated with the individual team members. Patients and their
families/carers may be seen in their own home, in the Day Centre, as out-patients, in the Inpatient Unit or at another suitable venue in the community.
Referrals
Referrals to the Macmillan Family Support Team may be made by any member of the Specialist
Palliative Care Team. Referrals from the Primary Healthcare Team may also be made direct to
the service, although clients would normally have had a connection with Ashgate Hospice or
another specialist palliative care team previously. Patients, carers, family and friends may also
self refer to the service.
Referrals are received by phone, e-mail or letter. Prior to the referral being made, where
possible, consent should be obtained from the person being referred.
Following assessment the client will be offered a full explanation of the services which are
available and suitable to meet their individual needs. This will include:
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Information on local and national support and signposting to appropriate services
One to one support either face to face or by telephone
Group support
Referral onto other agencies in the event of complex grief reaction and/ or mental health
problems, which cannot be safely managed by the Family Support Team e.g. suicide
risk.
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CHAPLAINCY
Introduction
The Chaplaincy service is provided by the Hospice Chaplain, assisted by a small team of
volunteer chaplains. The aim of the service is to provide spiritual and emotional support to
patients with life-limiting illnesses and their families and carers.
Service Availability
The service is available during normal working hours, Monday to Friday. Spiritual support may
be provided outside these hours by the Chaplain or volunteer chaplains, subject to a chaplain
being available.
Referrals
A referral to the Chaplaincy Team can be made by any member of the Specialist Palliative Care
Team. Patients, family, carers and friends may also self refer. Referrals are received by Referral
Form, telephone, e-mail or letter.
The Chaplain ensures that the spiritual needs of patients and their carers are assessed and
addressed and offers support, training and advice to other professionals within the Palliative
Care Team and delivers teaching sessions on relevant topics on both in-house and external
Study Days.
EDUCATION
Introduction
The hospice has an education department, the function of which is to provide training and
education in palliative care for both hospice staff and volunteers and members of the health
community, including the primary care team and staff in community and acute hospital, nursing
and residential homes.
Service Availability
The hospice runs a number of courses during the year. Recent topics have included End of life
care, communication skills and symptom management. However, the hospice is prepared to
develop tailor made events according to need.
The majority of the training is provided by our Professional Development Adviser, supported by
the Consultants in Palliative Medicine, Macmillan Nurses and Hospital Clinical Nurse
Specialists.
To request training in specific areas of palliative care or to find out more about planned training,
please contact the Professional Development Adviser.
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