1. The Changing Role of St. John’s Hospice in Specialist Palliative Care Wendy Johnson Director of Nursing and Quality St. John’s Hospice 16 th November 2009

2. The End of Life Strategy Caring for those approaching the end of life is one of the most important and rewarding areas of care. …….if staff have the necessary knowledge skills and attitudes, it can be immensely satisfying. End of life strategy. (DOH 2008).

3. Why do we need change?  2005 BBC survey –only 34% discussed wishes on dying  2007 –54% complaints relate to care of dying (HHC)  500,000 die each year in England, nearly 60% in hospital, but 70% say they would prefer home

4. What needs to be done?  Move specialist palliative care forward  Develop services appropriate to the local population (DOH 2005)  To recognize the established quality care  Need to provide staff who are competent/ confident  To share best practice/collaboration  Partnership working  To act responsibly and LEGALLY  To build on the vision of Dame Cecily Saunders

5. Why does this involve hospices?  Hospices have been recognised as providing excellent specialist palliative care (DOH 2008)  Offer a multidisciplinary/multi-faceted approach  Experienced in the changing health environment  Patient and family are central to the holistic care offered  Hospice part of the wider Community  Focus on quality

6. St. John’s Hospice, Lancaster St John’s has been established since 1985 offering specialist palliative care to the Lancaster area including parts of Cumbria. Over 100 staff are employed by the hospice, supported by a large team of volunteers

7. Structure Board of Trustees 16 trustees from many walks of life who oversee the running of the hospice. New Chairman of the Trustees in Autumn. Management team St. John’s in line with many hospices is changing its management structure. These include: Director of Nursing & Quality - Nurse Managers Chief Executive Clinical and ancillary staff

8. In- patient ward  In patient ward - 20 bed unit (currently being refurbished) – offers specialist palliative care (not just cancer) o Multidisciplinary approach to holistic care for symptom control, end of life care, specialist support, respite care, treatments, convalescence Nursing team: Ward Manager - Qualified and unqualified staff with palliative care experience

9. Clinical team  3 consultants in Palliative care  Palliative care doctor  Macmillan GP, end of life lead in palliative care In addition training for:  GP registrars  Medical students

10. Oak Centre  Day centre for patients with life-limiting conditions  Extensive programme  Complementary therapies  Support for family and carers Team: Team Leader, Qualified nurses & assistants – supported by volunteers, Allied health care professionals, clinical team, family support team

11. Community Services  Outreach team - Manager, 3 trained staff one auxillary  Lymphoedema service  Out Patients Clinics  Macmillan Nurses (managed by PCT) Domiciliary Visits by Occupational Therapist

12. Other Services  Allied health professionals  Family Support Team In addition Ancillary Staff Administration Staff Fundraising Team Volunteers

13. Education & Research Team  Palliative education provided by Lecturer Practitioners, Clinical Team  In house/external courses/care home training  Training & Development for Student/Nurses Research team : Carry out clinical trials, co- ordinate research programmes. Led by Professor Mike Bennett includes clinical research co-ordinator, clinical research nurse

14. Links with outside organisations  Other health professionals eg. District Nurses, Macmillan Nurses, GP’s, Care Homes, Hospitals, Hospices.  Academic professionals eg. University of Cumbria, International End of Life Observatory, Liverpool University  Voluntary Organisations: Macmillan, Cancer Care, Marie Curie, MND association

15. Current projects MND clinics – working with Nurse Specialists including MDT meetings and one stop clinic. ? Extend long-term conditions clinics Breathlessness service Gold Standards Facilitator

16. Current Projects Oak Centre Children’s project – visiting primary school Prince’s Trust programme Carer’s week In patient/Clinics Workforce planning audit Research trials/studies & audit

17. What can we achieve? QQuality care to patient/family or carers using a holistic approach SSupportive environment in which staff can be nurtured DDevelop more systems including audit/ evaluation/quality markers PProvide care using evidence based practice EEnsure person-centred care remains the impetus for developing services further CContinue to work to the ethos of the hospice SShare best practice/benchmark

18. Challenges  Extension of services – skilling-up the workforce  Substantiated funding  Rising expectations of healthcare – ‘baby- boomers’  Changes in demographics and disease patterns  Equity of services  More flexible working  Commissioning/policy requirements …….to name but a few

19. In the future …….  More nurse led clinics  Increased complimentary therapies  Education and training  Research programmes  Develop audit and evaluation  User group  Network and work alongside like- minded organisations

20. Thank you Any Questions?

21. References  End of Life strategy DOH (2008) Crown Copyright  Taking the lead engaging people and communities DOH (2008) Crown Copyright  Delivering choosing health: making healthier choices easier ( DOH 2005) Crown Copyright  Help the Hospices (2007)