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Annual Report and Accounts2018/19

Registered Charity No. 700636

This year, we looked after 1,680 patients at home, 414 patients on our ward and supported 476 bereaved family members.

Healthcare Assistant, Chrissie, with patient, Victor, on the ward

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Doctor Becki and Healthcare Assistant Joel, on the ward

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Contents

A special thank you to Ellie Rhodes, from EKRpictures, who is our volunteer photographer and has kindly provided most of the photographs in this Annual Report free of charge.

Welcome from the Chair and Chief Executive

About Ashgate Hospicecare

Governance and Trusteeship at Ashgate

Our Strategic Priorities

Why Your Support Matters

Our Care

Retail

Our People

Fundraising

Reference and Administrative Information

Financial Review

Trustees Responsibility for the Financial Statements

Independent Auditors’ Report to the Trustees of Ashgate Hospicecare

Consolidated Statement of Financial Activities

Balance Sheet

Cashflow Statement

Notes to the financial statements

Schedule of Restricted Funds Expenditure

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72

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Welcome from the Chair and Chief Executive

We are delighted to welcome you to the 2018/19 Ashgate Hospicecare Annual Report and Accounts. In these pages you will be able to read about the care that we provide and the work that we do to raise the money to fund that care.

This has been the last year of our 2014/2019 strategy. The achievements of Ashgate staff and volunteers are far too many to list here. However, the highlights of the last five years include: an outstanding rating from the Care Quality Commission (CQC) in 2015; provision of everyday community services; greater reach and accessibility of our supportive care services; and more collaboration with local partners. We now offer a regular programme of: evening seminars for healthcare professionals across North Derbyshire; education and mentoring support for nursing and care home staff; and training about Lymphoedema for primary and community care teams.

We have invested in quality improvement work and in learning and development for our workforce. In particular, this includes clinical skills for staff who care for our patients, and leadership development across all of the hospice teams. We established the Ashgate Furniture Co. We now have 15 Ashgate Hospicecare shops and three coffee shops all across North Derbyshire that are part of the social fabric of local neighbourhoods. Our fundraising events, like the Sparkle Night Walk, Open Air Cinemas and our Summer and Christmas

fairs represent the need for our care.

We are hugely blessed to be well-loved by local people and by our many corporate donors, who have supported us from the earliest days by raising vital funds for our services. Last year our shops raised over £3m in revenue and our fundraisers generated over £4m, all thanks to the support of the people of North Derbyshire.

The achievements that were inspired by the previous strategy give us a strong foundation to move into the future. This year we have worked with staff, volunteers and other stakeholders to develop a new vision and purpose for everyone who works for Ashgate. We have agreed new values to reflect everything that shapes our care. All of this underpins our new strategic priorities, which will be reviewed on a rolling basis to ensure that they are relevant in a world which increasingly requires us to be flexible, creative and open to change.

This creativity and openness to change are crucial to ensuring that Ashgate is able to continue to serve our community. We care for thousands of patients and their loved ones every year, whether in the hospice at Old Brampton, out in community hubs or in patients’ own homes. We are at the heart of the North Derbyshire community and that community is changing too. People are living longer and many have more complex needs.

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That change is already being reflected in unprecedented demand for our services. Since 2014, referrals to Ashgate have more than doubled. Our NHS funding has remained the same over that time and so we have a year-on-year reduction in real terms.

Our fundraising and retail teams, our many supporters and all of our staff and volunteers have worked very hard to make sure that we have the funds to provide our care. However, the gap between need and resource is widening.

As we move into the future, we have a responsibility to ensure that Ashgate remains at the heart of good palliative and end of life care in North Derbyshire. The

coming years will bring important and necessary choices and new ways of working to ensure that we are able to continue to provide care for the people who need us most. We must adapt to change to ensure that Ashgate is here for the future.

In closing, we want to pay tribute to everyone who works so hard to provide and to fund our care. We are entirely dependent on the efforts and passion of our 700 volunteers and 340 staff who live our values in ways which are inspiring and moving. You make a difference every day to people whom you may never even meet but who turn to Ashgate at their most precious and precarious times. We are proud to be associated with you. Thank you.

Barbara-Anne Walker Chief Executive

Nicholas Jeffrey Chair of Trustees

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Ashgate Hospicecare provides specialist palliative end of life care and support for adults with life-limiting illness, and their families, who live in North Derbyshire, an area of approximately 800 square miles.

Area we cover

DE45SK17

SK23

S80

SK22

DE4

S40

S43

S42

S45

DE55

S44 NG20

S41

S18

S21

S32

S33

Chesterfield

Hospice

Bakewell

Matlock

Alfreton

Pilsley

Dronfield

Staveley

Worksop

Eckington

Bolsover

Shirebrook

HathersageWhaley Bridge

New Mills

Edale

Buxton

Ashgate Hospicecare is a charity (no. 700636) that provides care and support, free of charge, to patients with a life-limiting illness, and their families across North Derbyshire, both at the hospice and out in the community.

For patients with the most complex needs, we have an Inpatient Unit. However, most of our patients are cared for at home and can attend our Day Hospice if their symptoms need close monitoring. We have a team of specialist nurses and healthcare professionals who visit patients at home. This enables them to stay where they feel most comfortable for as long as possible.

Ashgate Hospicecare is mainly funded through donations, gifts in Wills, our Ashgate Lottery, and income raised through our shops and coffee shops. Patients with any life-limiting illness can access Ashgate Hospicecare’s specialist services through a referral, normally through their GP.

About Ashgate Hospicecare

About AshgateDay Hospice Nurse Veronica with patient David

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Victor with his loved one on the ward

Ashgate Cares

Our vision

That everyone in North Derbyshire with a life-limiting illness, and the people important to them, can make the most of every moment together and that they can die with dignity and comfort.

Our purpose

To provide specialist palliative and end of life care for those in need and to work in partnership with others to ensure that everyone in North Derbyshire has access to appropriate, high-quality and sustainable palliative care.

We are compassionate. We work as a team. We are respectful, open and inclusive.

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Governance and Trusteeship at Ashgate

Our Board of Trustees consists of all volunteers who bring a range of professional expertise and lived experience to shape the direction of our strategic approach. Trustees are not involved in the day-to-day management of the charity. They delegate this responsibility to the Chief Executive and the Leadership Team. They hold them to account for ensuring that the hospice is managed effectively and in line with the highest standards of quality and customer service.

There is a full Trustee induction and Trustees take part in the role-specific essential training provided by the hospice for all staff and volunteers. Trustees also take part in Quality Visits to clinical services and shadow both clinical and non-clinical teams to gain assurance about performance and quality, to introduce themselves to staff and volunteers and to increase their knowledge of our services.

This year, the Board undertook a comprehensive review of the governance of the charity and, as a result, has developed a new Ashgate Governance

Framework. The framework sets out a robust hospice-wide governance and assurance structure with fully developed operational alignment and an emphasis on the ‘golden thread’ from frontline to Board.

As a result, there are now three committees which report directly to the Board and whose membership is drawn from the Trustees and senior managers. The Healthcare Quality Committee includes clinical quality and safety, evidence-based care and patient experience in its portfolio. The People, Engagement and Performance Committee has a focus on our staff and volunteer workforce, on information governance, IT and digital development and community engagement. The third committee is Finance and Strategy which is charged with governance of our income generation, our reserves and investments, procurement and estate management.

This framework enables the Board meetings and development days to focus on long term strategy, oversight of the charity’s performance, risk management and sustainability. The Board and the Committees meet on a quarterly basis.

This year we were delighted to welcome a new Chair to Ashgate. Nicholas Jeffrey brings a wealth of business and governance experience from the business world and from his previous roles as Chair of Sheffield Children’s NHS Foundation Trust and Chair of Sheffield Hallam University’s Board of Governors.

Nicholas was appointed following the departure of Jean Horton who had reached her term limit as Chair. Jean is a stalwart supporter of our work and she shepherded the hospice thoughtfully and carefully through many years of growth and change. We were delighted when she agreed to continue her connection to Ashgate by becoming one of our Patrons.

Public BenefitThe Trustees have referred to the guidance contained in the Charity Commission’s general guidance on public benefit when reviewing the Hospice’s objectives and in planning its future activities. In particular, the Board of Trustees considers how planned activities will contribute to the objectives they have set. The Trustees are confident that this report appropriately reflects public benefit in some detail when describing the purpose, objectives and strategic plans, services, service developments and future plans for continued or enhanced service delivery.

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Our diverse communities

Ashgate will ensure that the diversity in our communities and geographies

is recognised and reflected in our services and how they

are delivered. We shall work to ensure equity of access for everyone who needs our care in North

Derbyshire.

Our Strategic Priorities

Our specialist care

Ashgate will continue to be the leading specialist palliative care provider in North Derbyshire. We shall ensure that we are able to

continue provide high quality services to meet the changing needs of our population in ways which are safe

and sustainable.

Our presence in the community

Ashgate will extend our presence in local communities. This will enable more patients to access a range of support locally and

to be cared for in their own homes.

Our role as a system leader

Ashgate will advocate for compassionate and high-quality

palliative care for all. We shall influence local practice by being

an education leader, by developing partnerships with other local and national providers and

commissioners and by engaging with the research community.

Our culture

Ashgate will build a culture which puts our patients at the centre of everything

we do. Our work will be grounded in our values and in our commitment to being

the best we can be for our patients, our workforce and our supporters. We shall create the conditions to inspire

leadership and innovation and to support our staff and volunteers

to work together with trust and respect.

Our income and business

We shall generate the income we need to provide our services by continuing

to invest in our fundraising and retail activities. We will explore new

opportunities to raise additional funds by investing in new business

opportunities and diversifying our income streams.

Quality of our care

Ashgate is committed to ensuring that everyone for whom we care, and every

customer or supporter, receive the highest quality service that we are able

to provide. We shall embed an ethos and practice of continuous quality

improvement across Ashgate and aim for excellence in everything

we do.

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Why your support matters

Ashgate Hospicecare is a charity; we are not part of the NHS. In 2018/19 our running costs were £10.8m, which is an increase of £0.55m over the previous year . We only received £2.9m from the NHS, which is unchanged from the previous year, despite increased demand and a consequent increase in the cost of delivering our services of over half a million pounds.

This represents the lowest proportion in recent years, a trend which is likely to continue. The remainder of the funding, £7.9m, to provide our services has to be generated by fundraising and by our shops and coffee shops. The chart below shows our income compared to the previous year:

We have 15 Ashgate Hospicecare shops and three coffee shops

Our Ashgate Hospicecare shops and coffee shops are a vital source of funding. Last year, we generated income of over £3m from the sale of donated and new goods and Gift Aid. Not only that, our shop staff and volunteers truly are community ambassadors for the hospice. They are the friendly face of Ashgate Hospicecare in each of our locations across North Derbyshire.

We are fortunate to have the support of local businesses

In 2018/19, we benefited from Gifts in Kind totalling £116k. These ranged from the loan of vehicles to the gift of equipment and from food supplies to the sponsorship of our flagship event, the Sparkle Night Walk.

Legacies

Legacies have been a crucial part of our income and have enabled significant transformation of our facilities for the benefit of patient care in recent years. In 2018/19, we have been grateful for a particularly high level of legacies. This is an area of continued focus.

0 500 1,000 1,500 2,000 2,500 3,000

Restricted Donations

NHS Funding

Trusts and Grants

Gift Aid

Gifts in Kind

Other

Shops

Legacies

Community

Donations and In Memory

Events

Lottery

2017-18 £k 2018-19 £k

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Overall fundraising income (including income from donations and in memory giving, trusts and grants, gifts in kind, legacy donations, the Ashgate Lottery, and community and events fundraising) was £4.67m in 2018/19. This is a substantial increase from £4.30m in the previous year. As a result of the increased income from our supporters, we were able to increase what we spent on caring for patients and their families from £5.93m (2017/18) to £6.59m (2018/19).

1,076 people were cared for at home by our

Palliative Care Specialist Nurses

611 people were assessed

and provided with vital equipment at home by our Occupational

Therapists

211 people attended our Day Hospice

409people have received

2106 hours of one-to-one support through art therapy,

bereavement care, counselling, psychological support, social

work and spiritual and religious care from our

Supportive Care Team

438 admissions to our

Inpatient Unit, of whom 35% were discharged

to be supported at home

620 people were helped

by our Physiotherapy team

This chart shows our spend on income generation compared to the previous year:

We take a long-term view of investment in fundraising and marketing as being necessary, not just to generate income for the current year, but to secure the future of the hospice. This has been our approach for the last four years and we are beginning to see the impact. However, we remain focused on long-term sustainability, because we know that the need for our services will continue to grow.

0 500 1,000 1,500 2,000 2,500 3,000

Marketing and Communication

Fundraising - Support costs

Shop - Support costs

Shop - Expenditure

Legacies

Community

Donations and In Memory

Events

Lottery2017-18 £k 2018-19 £k

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Patient Sue choosing her lunch with volunteer Jean in the Day Hospice

Our Care

We care for people who need specialist palliative and end of life care, and for their families. We work to provide the best possible medical, emotional, spiritual, and social support. We know that there is rising demand for palliative care because people are living longer with more complex and multiple conditions, and we are seeing more patients with greater social care needs.

Ashgate has responded to this change and growth in demand for our care in recent years by growing our frontline services. This year, we have made additional investments in the resources, governance and service delivery work. This enables us to implement the

methodology and tools to improve our quality of care and patient outcomes.

We are committed to making sure that everyone in North Derbyshire has access to appropriate, high-quality palliative care. Consequently, we collaborate with other local end of life care providers to ensure equity of care for the people we all serve. We want to ensure that the diversity in our communities is recognised and reflected in our services and how they are delivered. As a result, we have continued to build relationships with local communities and groups to understand their specific end of life care needs and how the hospice can best support them.

What is palliative care? What is end of life care?

We have a number of different teams at the hospice who provide specialist palliative care for people with a life-limiting illness. We seek to understand how our patients are feeling, alleviate pain and ease any distressing symptoms. Our aim is to help patients maintain their dignity and independence. We aim to improve quality of life for our patients and their families.

We aim to provide our patients with a clear understanding of their diagnosis and discuss their care plans. Palliative care is about finding the best ways to provide relief from physical symptoms, as well as relief from the mental and emotional stress of a terminal diagnosis.

At Ashgate Hospicecare, we provide care and support for patients who have been diagnosed with a life-limiting illness. We shall continue to support our patients and their families as their condition changes and progresses.

As end of life care providers, we believe it is important and necessary to have conversations with patients about their care. This includes what treatments they would like to have, how they would like their care to be managed and where they would like to be as they become more ill and when they die. Our aim is for our patients to make informed decisions as early as possible, and to have the knowledge that they can change their decisions at any time.

Our Care14

Collaboration

This year, Ashgate Hospicecare has been working more closely than ever with our clinical colleagues at Blythe House Hospicecare, in Chapel-en-le-Frith, and Chesterfield Royal Hospital. We know that most of our patients will have accessed any of the North Derbyshire healthcare services before being referred to us for specialist care. It is vital that we work in close partnership with healthcare partners to ensure that patients are receiving the best care from diagnosis of a life-limiting illness onwards.

Ashgate Hospicecare’s Medical Director, Dr Sarah Parnacott runs an outpatient clinic at Blythe House Hospicecare. Our Palliative Care Specialist Nursing Team works closely with the community nursing team at Blythe House. We work collaboratively to ensure that mutual patients are receiving the best palliative and end of life care, including physiotherapy and occupational therapy.

We also work very closely with Blythe House Hospicecare when it comes to bereavement support. For example, if it isn’t a suitable option for someone who has been bereaved to be offered support by Blythe House, then our Supportive Care Team will step in to offer care, and vice versa. Our relationship with Blythe House Hospicecare is vitally important in delivering a network of patient care and family support across North Derbyshire.

We have long played an active role in the Derbyshire Alliance for End of Life Care to increase the availability of palliative care education across the county. We received funding from Health Education England East

Midlands which has allowed us to offer more learning and development and to provide free education, including the SAGE & THYME and ReSPECT sessions (see below for more information), as well as bespoke sessions from specialist individuals.

We are working with the local NHS Sustainability and Transformation Partnership (STP) to agree and implement priorities for palliative and end of life care in North Derbyshire, and countywide. This work has included the implementation of new electronic solutions to coordinate patient care across organisations and sectors. We collaborated on a cross-Derbyshire policy to help family carers administer pain relief to patients at home by injection outside normal working hours when clinicians may not be easily available.

We have strong links with local heart failure nurses who run clinics at the hospice for people who need this specialist support. We continue to liaise very closely with local respiratory nurses and the specialist neurological team from Chesterfield Royal Hospital to support the referral of patients who need ongoing specialist palliative care support from the hospice.

Our current plans include developing a collaborative project with hospice colleagues across Derbyshire to explore how we can improve the palliative and end of life care experience of patients with dementia.

Our Care

Ashgate Hospicecare’s Medical Director Dr Sarah Parnacott runs clinics at Blythe House Hospicecare for patients in the High Peak

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“In February 2011, my husband, Geoff, was diagnosed with MSA. We were told that Geoff would gradually lose the ability to do things, so in that first year while he was still very mobile, we went away a lot. However, in early 2012, Geoff had a fall in the snow and hurt his back. He never properly recovered and from then on, he really started to decline.

Geoff was then referred to the hospice and Lesley, a Support Worker, came over for half a day each week to help me so that I could get out. She’d say, “Right Carole, off you go! Do any jobs you need to do, meet friends, whatever you want. I’ll see you later!” She told us about the Day Hospice. Geoff was really keen on the idea, so he started going there every Friday and really enjoyed it. That gave me a bit of a break too. He had so many laughs there with the staff and the other patients. Having all of that support was wonderful.

Then in 2013, Geoff took a turn for the worse and was offered a bed at the hospice, where he stayed for a few weeks. He had fantastic care while he was there. Geoff was quite happy when Lesley suggested it because she

explained that it was just to control his symptoms and then he could go back home. That gave me a much-needed break from caring, plus Geoff was able to have lots of physiotherapy sessions to help his back pain.

I went in to visit him every day on the ward with our little dog, Jacob, who was very popular with lots of the other patients and their families! There was a lady, in the room opposite Geoff’s, who was very ill and I got to know her daughter who was with her all the time. She said to me one day, “I’ve got a favour to ask you. I hope you don’t mind, but could you bring your little dog in to see my mum?” Normally, Jacob is very excitable when he meets new people, but I picked him up and put him on this lady’s bed and he just lay there licking her hand. A big smile came across this lady’s face. She couldn’t speak, but the daughter was talking to her saying, “Remember when so and so had a dog, mum?” We were there for about 10 or 15 minutes until the lady started to look tired and so I said I’d leave them. The next day, the daughter came up to me and said, “I don’t want any tears because my mum is now out of pain. She died last night and I wanted to tell you that I’m so grateful for what you did.” I said, “I didn’t do anything! I only brought the dog in and laid him on the bed!” But she told me that it was wonderful.

Geoff and I spoke about what might happen as he got more ill. The staff at the hospice made sure to have those conversations with us too. We were very open about things like that since it was important to both of us to know what kind of treatment Geoff wanted. It was Geoff’s wish to die at home, but he said that if he couldn’t die at home then he wanted to die in the hospice. I agreed that it was the best place for him if he couldn’t be at home.

Geoff died much sooner than we’d expected. It started when he got a urine infection one Friday and, by the Sunday, he had to be taken into hospital. It was a really scary time for us because it wasn’t until the Tuesday that they could find out what kind of antibiotics Geoff needed. All the while he was getting worse and worse.

Carole’s Story Carole and her husband Geoff, from Dronfield, had their lives turned upside down when Geoff was diagnosed with a rare degenerative disease known as MSA (Multiple System Atrophy). Carole shares her story about how the Hospice provided vital support through Geoff’s illness.

Our Care

Carole and Geoff with their two sons, Dom and Alex, and their dog Jacob

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I was so worried about Geoff that on the Tuesday I rang Ashgate and spoke to Dr Sarah Parnacott. I explained our situation and Dr Parnacott got one of Ashgate’s specialist nurses who was based at the hospital to come and see us. She was lovely and really helped to put me at ease. She said that as soon as Geoff got on the right antibiotics and started to improve, they’d move him back onto the ward at the hospice.

Geoff was so relieved when he came back to the hospice. They’d even managed to put him in the same room he was in before, which he really liked because it was an individual room with a little patio. He said it felt like going home. He wasn’t well, so I didn’t want to leave him, but I was with Geoff’s sister who had travelled a long way to see him, and so Geoff said I should go and take her to the station. He told me he was fine. I came away, but I didn’t feel happy coming away. I knew he wasn’t right.

Our son, Dom, had come home from Newcastle that evening and so I met him at the station and we decided to get a takeaway and go home. Just as Dom had finished eating, we got a phone call. Dom answered the phone and I realised it was the hospice. I thought Geoff had died and I was kicking myself thinking, I knew I shouldn’t have come home. But Dom told me he hadn’t died. He put the nurse on to talk to me and the nurse said, ‘Mrs Aitken, your husband is very unwell. He was insistent we didn’t ring you, but obviously we wanted to let you know that he’s not doing very well so you can come and see him.’

I drove to the hospice immediately. I rang our other son, Alex, who was living in the South and told him to get up here as soon as possible. By 4 a.m., everybody had arrived to be with Geoff: my sons and their girlfriends and me. Geoff was still trying to speak and he was aware we were all there, but we knew he was nearing the end. The staff were wonderful with us throughout that time. They offered us recliner chairs so that we could stay with him overnight.

I knew Geoff was dying but I really needed a break. I went into the Chapel and wrote a prayer asking forGod to take Geoff now; he was very tired and I didn’t

want him to suffer any longer. The moment I put the prayer into the box, I heard footsteps running down the corridor and I instinctively knew it was Laura, Dom’s girlfriend. She told me to come quickly and when I got there, the doctor told us Geoff had minutes left.

We were all there when Geoff died. The hospice staff were fantastic. They made sure nobody disturbed us and we stayed for hours. It was incredible because within just ten minutes of Geoff’s dying, you could see all the pain that he’d been carrying just lift and he looked like my Geoff again. He looked ten years younger! He had a very peaceful death and we’ll always be grateful for that. We were all given the space to cry and laugh. My son Dom was able to give his dad a shave after he died; something he’d promised to do when Geoff was in hospital but never could because he was too ill. He did it very carefully as he wanted his dad to look perfect.

I can’t praise Ashgate enough for the care they gave Geoff and our whole family. I feel like we were very lucky because I’ve met many MSA sufferers and their carers from all over the country and not all of them have had the kind of support we had. With the help of the hospice, Geoff almost got his wish to die at home, and in the end he died in the next best place.

The support didn’t stop when Geoff died. I was offered bereavement counselling which I did for about a year. I also attended a bereavement group which was really helpful. There were people there of all different ages and we’d all gone through similar things. I got so much out of those sessions and they really helped me to put things into perspective. Ashgate even rang my sons and asked if they wanted counselling. We didn’t expect that at all. Although they declined, I thought it was really nice that the hospice was thinking of them.”

Carole’s husband Geoff was cared for by Ashgate Hospicecare after being diagnosed with MSA

Our Care 17

Education

We have continued to provide a varied programme of evening seminars as an educational resource for the healthcare community of North Derbyshire, as well as for our own workforce. Our intention is to upskill professionals who work in partner organisations so that everybody with a life-limiting illness in North Derbyshire is able to have a positive end of life care experience. This is whether they be in the hospital, in a nursing home, in a residential home or being cared for in their own home. Our role at Ashgate is to care for patients who have specialist needs, but we are committed to ensuring that all local healthcare professionals are able to provide the best end of life care for everyone.

We provide learning opportunities to support better conversations with patients and their loved ones. We offer regular SAGE & THYME workshops which have proven to be very popular. SAGE & THYME provides a structure for conversations, based on the evidence behind effective communication skills and offers a way to engage effectively with patients. These workshops are open to our staff and volunteers and to care professionals in the wider community. The SAGE & THYME workshops have enabled us to build relationships with professionals from general practice, nursing and care homes, social care, and mental health services, as well as local charities and

ambulance crews. Every participant has come along to try and improve their communication skills and to make those difficult conversations more effective and more patient-centred. It’s all about listening to patients and empowering them and helping to fulfil their wishes with regards to their care.

With some of our evening seminars this year, the aim has been to support the resilience of our staff and volunteers. Working or volunteering for a hospice is immeasurably rewarding and can be an unusually meaningful experience but, like most work, it can also be challenging and occasionally stressful. We have offered a number of workshops and presentations to help our staff and volunteers understand and care for their mental and physical well-being.

We are delighted that our programme of evening seminars continues to be so well attended and to generate so much positive feedback from participants. Many of the people who attend choose to come in their own time which shows real commitment from the local healthcare community to improve the care they’re providing. Ashgate will continue to provide leadership in specialist palliative and end of life care and to develop our education offer for professionals across North Derbyshire.

Schwartz Rounds

Schwartz Rounds, an initiative introduced by The Point of Care Foundation, is a reflective practice forum that provides an opportunity for staff and volunteers from all disciplines to reflect on the emotional aspects of their work. The forums were introduced into Ashgate Hospicecare in 2016. Their aim is to get the entire hospice staff and volunteers together to talk about difficult situations they may have found themselves in and how they felt about them.

A topic is chosen for each of the Schwartz Rounds, and three people are invited to share their story, of up to

five minutes about a particular incident. This could be about a memorable patient or a difficult day at work. Following that, there is an open forum for other people to share how they felt when they heard the stories and to share their own similar experiences. By talking about their experiences, research has shown that the Schwartz Rounds increases staff and volunteer resilience, keeps them healthy and, more importantly, improves the care we provide to patients and their families.

Our Care18

ReSPECT Process

The ReSPECT Process (Recommended Summary Plan for Emergency Care and Treatment) started being rolled out across Derbyshire from the end of June 2018. ReSPECT is a process that creates personalised recommendations for a person’s clinical care in a future emergency when they are unable to make or express choices.

ReSPECT is about having conversations about what’s important to patients. This includes: where they want to be cared for as they become more poorly; what they want to happen to them and what they don’t want to happen to them; and where they want to die.

The conversation will also hopefully explore their wishes about resuscitation. It’s about having at least one conversation, doing it well and making sure that it’s recorded for other health and social care professionals to see. So again, it’s about trying to improve the end of life care for people and trying to prevent unnecessary hospital admissions.

We’ve started using the ReSPECT Process on the Inpatient Unit, within the Day Hospice and in all our community nursing teams. We want all our medical and health care staff to feel empowered to have conversations with patients and their relatives about their wishes for the future.

Introducing the ReSPECT Process is a campaign across the UK. It is recommended, but not compulsory for healthcare organisations. Therefore, Ashgate Hospicecare has been working with the South Derbyshire teams as part of the STP end of life care group. We’ve worked with Chesterfield Royal Hospital to implement the ReSPECT Process there. We’ve also offered bespoke education about ReSPECT across the whole of North Derbyshire. The more organisations use the ReSPECT forms with patients, the more people can be cared for according to their wishes.

Our Care

ReSPECT is about having conversations about what’s important to patients

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Ann on the ward with her loved ones

Our End of Life Care Facilitators work across North Derbyshire to support staff working in community settings to deliver high-quality palliative and end of life care to their patients. The team works with nursing and care homes, GP practices and community nursing teams.

There are 2,000 people being cared for in homes across North Derbyshire and approximately 22% of deaths take place in nursing and care homes. Evidence shows that providing end of life training to nursing home staff significantly improves the quality of life for residents. It also reduces hospital admissions and deaths. In practice, however, accessing training can be a challenge for these colleagues, due to the wide geographical area that the hospice covers.

This year saw the introduction of a new way of delivering education and mentorship to nursing home staff using Project ECHO. Project ECHO uses web-based technology which means that participants can dial in from their location to interactive sessions. These consist of a presentation and case-based discussions, and are coordinated by Ashgate, which is an accredited ECHO Hub.

In this way, staff learn how to provide excellent specialist care to patients in their own communities. This approach makes training cost effective and improves patient care by engaging a wider audience than traditional educational methods. This promotes evidence-based practice more effectively. The ECHO model encourages participants to decide the content, frequency and timing of the sessions to increase engagement.

We launched our first nursing home network this year and, to date, we have reached twice as many nursing

home staff compared with the numbers we have seen, using traditional methods of training.

The team has facilitated sessions on various topics that were requested by the nursing homes, using the expertise of hospice staff and of professionals outside the organisation. We are grateful to the professionals who have helped us to provide ECHO workshops. These include our own Consultants, Physiotherapists and Community Palliative Care Specialist Nurses, as well as a Speech and Language Therapist, a Tissue Viability expert, a GP, a Dementia Specialist, and a CQC Inspector.

It is hoped that this method will help to raise the standard of care for patients in the community with additional networks now being considered. GPs, community nursing teams and residential care homes have expressed an interest in developing their own networks.

An evaluation plan has been developed to assess the effectiveness of the model and to help ensure that the ECHO model can be sustained and developed in other areas. We are exploring the development of networks for GPS, for residential homes and a community nursing team network. We shall also be launching phase 2 of the nursing home network this coming year.

A full evaluation of the initial nursing home network will be undertaken when the current network finishes in October 2019. Early indications are that the ECHO approach has led to increased engagement from nursing home staff and has had a positive impact on their practice.

Project ECHO

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Ann on the ward with her loved ones

Our Day Hospice can accommodate up to 16 patients a day, four days a week. Patients attend the Day Hospice for an initial period of 6 weeks to complement the care we provide in their homes.

They come in on the same day each week. This means that they can get to know other people facing similar challenges. They can be assessed by our various medical teams, including consultants, nurses and physiotherapists. They can receive complementary therapies, do a range of activities from games to crafts, and eat a homemade lunch together.

This often provides vital respite to family members and carers looking after patients at home. It also gives patients a day to do something different and to focus on living well with their illness.

We also run a Living Well drop-in day at the Day Hospice once a week. This gives patients, who have been diagnosed with a life-limiting illness, but who don’t require medical assessments, the opportunity to spend time together.

During the year, we have been reviewing the way our Day Hospice service operates, with a view to improving patient experience and maximising the care and support our Day Hospice can provide. Looking to the future, we expect that our current Day Hospice model

will change and we shall be able to offer more to our patients and to increase the number of people who can access the service.

We are also planning to improve our Day Hospice environment to adapt to the changing needs of the patients we are seeing. We have identified, for example, that we shall need larger bathrooms containing fitted hoists. This is to improve the dignity and privacy of the care we provide, particularly to patients with conditions such as motor neurone disease.

This year, we launched the Horticultural Therapy Project, which is led by our Occupational Therapy Team with the support of volunteers. This project aims to give Day Hospice patients the opportunity to do some gardening and to enjoy spending time outdoors. We have received various funds for this project, which have enabled us to build a polytunnel with raised beds inside, which are suitable for patients in wheelchairs. We have also built a large shed with wheelchair access where our patients can make items or store their gardening tools. Horticultural therapy has been shown to improve the well-being and quality of life of people with a life-limiting illness. We know that already our patients are enjoying pastimes that some thought they would never be able to do again.

Day Hospice

Our Care

Activities Coordinator Ami speaking with patient Vera, in the Day Hospice

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The Palliative Care Specialist Nurse Team consists of Palliative Care Specialist Nurses, Palliative Care Nurses and Palliative Care Support Workers. This team supports patients and their families to improve quality of life focusing on prevention and relief of physical symptoms, psychological and social concerns. Working closely with other healthcare professionals, the team supports patients to make an informed choice about their care, while being supported to remain in their own home, which is where most of our patients would like to be.

The Community Palliative Care Specialist Nurse Team supports patients in the community across North Derbyshire, including central Chesterfield, North East Derbyshire and the Derbyshire Dales and High Peak.

The everyday provision continues to be a vital part of the service, meaning patients, families and heathcare professionals can receive telephone advice or face-to-face support at weekends and bank holidays. This has resulted in fewer patients being admitted to hospital or contacting emergency services when their condition worsens during these times.

The triage hub, made up of Palliative Care Specialist Nurses and Clinical Administrators, has been in place for just over two years. It has made a positive impact on response times for patients. The triage hub processes every referral that comes through to the hospice and uses the same equitable telephone assessment. The hub then assigns each referral with an appropriate priority, depending on the current situation of the patient. This year Sheffield Hallam University has been undertaking a research evaluation of our triage service. We are looking forward to the results, so that we can continute to improve our services to meet the palliative care needs of the patients in the community.

The community teams are currently being provided with new IT equipment, as part of a wider organisational project, to facilitate remote working. This will ensure electronic patient records can be shared between healthcare professionals and so improve the care for patients in the community. This exciting opportunity is in its early stages. We are working with Derby University on a further research project surrounding the challenges of remote working and improving the experience for patients and staff.

Community Palliative Care Specialist Nurse Team

Our Care

Patient, Kate, at her home in Hope Valley with her Palliative Care Support Worker LesleyPhotograph by Kate’s husband, Keith

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The Physiotherapy Team consists of four physiotherapists, therapy technical instructors and a driver. This team supports patients with a variety of problems including breathlessness, fatigue, discomfort, weakness, anxiety, mobility and pain. The team provides realistic and appropriate treatment models to help improve quality of life, promote independence and provide specialist advice. In addition, the physiotherapy team offers practical advice and emotional support for carers.

The Physiotherapy Team offers a high-quality service

to patients within our Inpatient Unit, outpatient clinics and in the community of North Derbyshire.

The service has extended its reach into our Day Hospice and holds seated exercise classes to groups of patients on each day the Day Hospice runs. It also offers daily games and activities designed to increase our patients’ movement and exercise tolerance, including individual exercise prescriptions. Future development plans include an exciting opportunity to obtain funding to establish a breathlessness management programme.

Physiotherapy

The Occupational Therapy Team consists of four occupational therapists, therapy technical instructors and a driver. This team promotes independence and quality of life for patients who have restricted normal activities of daily living. This includes an assessment of patients’ ability to manage in their home environment; advice regarding coping with restricted energy levels; and advice, training and provision of equipment to prevent hospital admission or facilitate timely discharge from the hospice or hospital. In addition, the Occupational Therapy Team offers practical advice and emotional support for carers.

The Occupational Therapy Team supports patients and families within our Inpatient Unit, Day Hospice and in the community throughout North Derbyshire. The Occupational Therapy Team works closely with

members of the Ashgate Community Nursing Team, as well as other community agencies. The patient’s choice is central to any decisions made.

The Occupational Therapy Team has successfully implemented an ‘emergency store’ via Medequip to provide emergency equipment for patients in a timely manner. The team has also been working closely with Day Hospice to implement its Horticultural Therapy Project which has improved the well-being and quality of life of patients who find gardening and horticultural therapy enjoyable and therapeutic.

Occupational Therapy

Our Care

This year, we introduced morning physiotherapy sessions for all our Day Hospice patients

With the help of volunteers, our Horticultural Therapy Project has been helping patients, like

Anne, to get gardening again

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The day I was transferred from hospital to Ashgate Hospicecare was grey, wet and windy. As I walked through the doors I started to cry. The first thing that happened was a total stranger came and sat next to me and asked if I wanted a hand to hold. It was such a small gesture, but it was so powerful. That is Ashgate. It holds your hand. In fact, for me it put its arms around me and hugged me.

I was put in a room with a view of flowers and a bird feeder. And the next day, when my son and partner came to visit, both said it was the first time in weeks they had seen anything like a smile on my face.

I know my time is limited, and sad things will happen here at the hospice, but it is not a sad place. It emanates calm, quiet happiness for simple things, and acts of tenderness from staff and volunteers. If you need to talk, they will talk. If you need quiet, that is there too.

Places like Ashgate Hospicecare are precious and the wider community must be made aware of this. They need support, and any sort of funding that you can give, however small, will help to keep hospices alive.

Hospices are not places to come to die, although I hope that is what I will be able to do. I can think of no gentler departure. Hospices are places to gently reflect, be cared for, and hopefully ease the inevitable for yourself and your family.

Look after the hospices, like Ashgate Hospicecare, in this country. No one can tell you how special they are until you need them. Please don’t lose them. They need all the recognition they can get.

Sheila Gray, Ashgate Hospicecare patient

Our Care

Sheila’s Letter

Patient Sheila and her family were touched by the kindness of the staff and volunteers on the ward

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We are committed to improving the quality of the care we provide. As part of this, we continue to review our estate and the environment in order to provide the highest quality of care and to run as efficiently and sustainably as possible.

This year has been characterised by vast improvements of the outdated inpatient environment. Improving our inpatient environment means that our nursing staff and volunteers will be able to provide higher quality care to patients. Our vision is for the whole of the Inpatient Unit, including the family areas, to feel like a home from home for our patients and their families.

Our Inpatient Unit was first built when the hospice was established 30 years ago in 1988. We had nine beds in three-bedded bays, three single rooms and a double room. Then in 2005, we were able to build a further eight bedrooms, increasing our beds to 21, but only 17 were open, due to a lack of funding. In 2014, the NHS recognised how vital the additional beds would be and provided 50% of our funding. We fundraised to make up the shortfall.

However, over time the needs of our patients have changed. As people are living longer, we are seeing many more people with more complex and multiple conditions as well as greater social care needs. In 2015, the CQC awarded us with an overall rating of ‘Outstanding’, but they recognised that our three-bedded bays were no longer fit for purpose and were having a negative impact on the quality of care we could give to our patients.

In April this year, our Bedroom Appeal was launched and we were able to begin the work needed to transform our three-bedded bays into nine modern, individual rooms, each with a garden view. The work is due to be completed in October 2019 and the new bedrooms will open in December 2019. As part of this transformation, Vine Hotels are also funding the renovation of our Family Bedroom, which will provide a beautiful room where families will be able to stay overnight at the hospice and be close

to their loved ones. We will also be redesigning and upgrading our mortuary. Finally, we have redesigned our Inpatient Unit counselling room. That will still be used for counselling, but may also be used for patients and their family members to have confidential conversations with any of our clinical staff.

As part of our plans to review our estate and the hospice environment, we hope to renovate the rest of our inpatient environment. This means that wherever people are in the hospice, they know they are in the hospice and the environment makes them feel at home, safe and supported.

As well as focusing on our environment, we are also committed to the training of our clinical staff. We’ve worked with the Learning and Organisational Development Team to review our workforce requirements. We have introduced two additional senior tier nursing roles, increasing the number of Ward Sisters we have from two to four. This will ensure that our inpatient staff have support from a senior member of the team at all times.

Finally, we have undergone a systematic review of our referral and admissions processes. In order to assess which patients are most in need of inpatient care, we have updated our admission criteria. In March 2019, we introduced a triage system which was designed specifically for our Inpatient Unit. This has improved our responsiveness in receiving inpatient admissions and has consequently improved the care that our patients are receiving.

Inpatient Unit

Our Care

Bob and his grandson, David, on the ward

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Lymphoedema is a chronic condition caused by problems with the lymphatic system. It results in swelling due to excess fluid in the body’s tissues, which can be very painful and uncomfortable. Lymphoedema can often be a side effect resulting from operations to treat cancer, but people can also be born with the condition.

The Ashgate lymphoedema service, which was established in 2003, is the only specialist lymphoedema service that covers the North Derbyshire area. It is a small team made up of a Lymphoedema Manager, two Lymphoedema Nurses, a Lymphoedema Technician and a volunteer administrator. Patients may be referred into this service from our Inpatient Unit, Day Hospice or from the community. The team run clinics at Ashgate Hospicecare and at Blythe House Hospicecare in Chapel-en-le-Frith.

In October 2017, the lymphoedema service underwent a systematic service review to identify areas where this service could improve efficiency and responsiveness. As a result, a bespoke triage model was designed for the service by Ashgate’s Quality Improvement Team and this was launched in July 2018. This included improving the referral process (our referral criteria, referral form and website) so that we can offer a more responsive service, decrease waiting times and improve patients’ experience. All patients referred into the lymphoedema service now receive a phone call to arrange an appointment within one week. Moreover, we are moving towards becoming a paperless office

and digitising our processes to improve data security. The team members are leaders in lymphoedema care and were proud to have had posters displayed at this years’ Hospice UK National Conference and British Lymphoedema Society (BLS) conference. In December 2018, the Lymphoedema Manager began a qualitative study on lymphoedema of the breast which can occur after a patient has had breast cancer. Little has been written about this yet and it is hoped that recognition of this type of lymphoedema will improve the care of patients who have had breast cancer.

The team will continue to work to improve our lymphoedema service. We know that when it comes to managing lymphoedema, we see best results when the signs of the condition are spotted early and referred to a specialist service. That’s why, as well as continuing to develop the most responsive service possible, the team runs educational sessions for healthcare professionals across North Derbyshire, in the hope that patients can be diagnosed and referred to the lymphoedema service as early as possible. The Lymphoedema Team is always open to healthcare professionals and students shadowing, and in one month alone as many as 15 visitors come to learn about the service. This is vital for improving the care of all patients in the North Derbyshire community who have lymphoedema.

Lymphoedema

Our Care

Our patients can receive complementary therpies, such as hand massages, whilst at the hospice

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Chaplaincy

Our Chaplaincy Team, which is made up of paid staff and volunteers, is there to lend a listening ear and also to support people as they reflect, explore and remember those they love. Our team can see patients and family members both at the hospice and out in the community. The team also offers religious care and, if requested, will arrange for visits by a patient’s own faith leader.

Complementary Therapy

Complementary therapies are non-medical treatments that can be used in conjunction with conventional medicine to promote the health and well-being of patients with advanced disease. Our complementary therapists can offer reflexology, body massage, Indian head massage, reiki and aromatherapy to patients on the ward and in the Day Hospice. Complementary therapies can help with symptom control and reduce some of the undesirable effects of treatments. They can also help to restore energy levels, reduce stress levels and anxiety and give a time for reflection, which can help to support physical and emotional well-being. In the future, we would also like to offer complementary therapies to patients and carers in the community.

Social Work

A review of our services and the types of patients we are seeing, both in the community and in our Inpatient Unit, has identified a greater need for social workers to help patients and families. These may be experiencing interpersonal difficulties. There is a need also to promote human rights and well-being. In response to this, we’ve increased our social work capacity by introducing new full- and part-time roles, working on the Inpatient Unit, in the Day Hospice and in the community.

Art Therapy

The art therapy service has continued to grow this year. We have one art therapist who now supervises a qualified art therapist volunteer as well as an art therapy trainee. We have worked in partnership with the Chesterfield Royal Hospital to provide an art therapy service over the last ten months for patients who are often on the wards for weeks and months at a time. This is currently being evaluated. We have also had a series of workshops within local schools where bereaved children have been experiencing difficulties. This work has been evaluated and is proving very successful for both the children and the teachers.

Supportive Care

At Ashgate Hospicecare, we don’t just look after patients, we recognise the importance of caring for our patients’ loved ones too. Supportive Care plays a very important role in this, offering support to adults and children who are caring for family members with a life-limiting illness or who are suffering with bereavement.

The Supportive Care service was formed two years ago to bring together chaplaincy, complementary therapy, social work, counselling and art therapy all under one umbrella. Over the past year, we have been increasing our volunteer capacity to support more people. As well as providing vital support to families at the hospice, we are also focusing on reaching out to those who may need this kind of support in the community.

Our Care 27

Counselling and talking therapies

This year, we have continued to increase the number of counsellors we have who can support patients and families. Currently, we have 20 qualified and trainee volunteer counsellors who make up this team. We would like the hospice to become a training centre for counsellors. We are establishing connections with Derby University and Sheffield University with a view to giving their counselling students placements at the hospice. This will mean that we will be able to provide high-quality support to patients and families at low cost to the hospice.

This year, we have focused on taking counselling and talking therapies into the community. We set up a weekly drop-in support group in Chesterfield and we are looking at setting one up in Darley Dale. At the end of January 2019, we set up a weekly young persons’ support group in Bolsover and we have already seen some of the benefits this group is having for young carers and young people who are bereaved.

Reflective Practice

This year, we created a new senior role within Supportive Care for clinical supervision and reflective practice. This role will give staff and volunteers in our clinical teams the support they require to continue to deliver the highest quality palliative and end of life care to our patients, both on the ward and in the community.

Oral History Project

In January 2018, the Oral History Project was set up, with the help of Michelle Winslow from the University of Sheffield. Michelle has over 10 years of experience in running these projects in palliative care. The Oral History Project is made up of a team of trained staff and volunteers from across the hospice and gives patients the opportunity to record their life story in their own time and in their own voice. Patients may wish to give to give these recordings to family and friends as a lasting legacy, and they can also choose to archive these at the University of Sheffield. They can then be accessed as social and historical resources for years to come.

Freedom to Speak Up Guardians

This year, we also established Freedom to Speak Up Guardian roles. The Freedom to Speak Up initiative was developed by the Care Quality Commission (CQC) and has been established in many NHS Trusts across the country. We believe we are the first hospice to introduce this initiative.

Freedom to Speak Up is designed to help speaking up become business as usual. If staff or volunteers at the hospice notice something happening that they believe is not best practice, and they don’t feel comfortable speaking to their line manager or Leadership Team about this, they may come to speak to any of the Freedom to Speak Up Guardians in confidence. The Freedom to Speak Up Guardians will then be able to bring the issue to the attention of the Leadership Team without revealing the identity of the person who spoke up. The hope is that this will foster a culture of speaking up. It should help us to solve any issues around safeguarding, malpractice or any other issues that may be compromising our ability to provide the highest quality care to our patients and their families.

Artist in Residence

This year, we secured the funding for an artist in residence. Throughout the next year, a trained artist will come into the Day Hospice for three months at a time to work therapeutically with patients. This will also give our staff and volunteers the opportunity to learn how they can use art as a therapeutic medium with patients into the future.

We are going to continue to bring supportive care to people in the community. Looking to the years ahead, we would like to open more hubs and drop-in centres where people can receive support when caring for, and dealing with the loss of, a loved one. We have identified the need to open these groups to everyone, not just people who have experienced hospice care.

Supportive Care

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Lynne’s Story “Everyone is treated as a person

and their wishes are taken into account.”

Sue (left) received dignified care at Ashgate Hospicecare

“My mum died on 1st November 1962, leaving me, who was seven years old at the time, my brother, who was ten, my dad, and my grandad. We’d lost my grandma a few months earlier.

In 1962, there were no hospices. Mum was taken to hospital to die and, because we were children, neither my brother nor I were allowed to visit her. The most upsetting thing is that, at that time, anyone close to death was often moved to the bed nearest the door. I was told this harrowing fact by my cousin who was old enough to visit at the time and it has stuck with me ever since.

There was no aftercare for our family either and no bereavement support. The result is that mum was never talked about. As a small girl, I was scared to ask any questions about my mum and I can only assume our dad didn’t talk about her in case he upset us. Perhaps he was trying to protect himself and not let his emotions show. He died twelve years later when I was 19.

As a teenager, I remember asking what mum died of. It was a quick answer: cancer. The conversation stopped at that. I was only left with about seven clear memories of her and I’ve written them down so I don’t forget them. It’s only been in the last few years that my cousin has told me snippets of what she remembers about her. Even though this answers some of my questions, it still leaves a loss that has affected me all my life.

For all these years, I’ve wanted to know why I was never allowed to see my mum when she was dying. The rule was that no children were allowed. It hurts that my cousin was allowed to see my mum, just because she was older than we were and that’s something that’s going to stay with me forever. Thankfully now, things are different.

My mother-in-law died on the same day as my mum, 33 years later in 1995. She was about to go into

Ashgate Hospicecare but she died more quickly than expected. The difference this time was that she wasn’t placed in a bed near the door. She was put into a private room in hospital and her family could visit anytime they liked. That was a blessing for us. Then I lost a lifelong friend in at Ashgate on 26th December 2017. We were friends since school and lived a few doors down from each other. She was the sister I never had. Sue died only three months after receiving her diagnosis, so it was a great shock to all of us.

Seeing the care that Sue received at the Hospice and comparing it to the care my mother had, I can say that the differences between them, 55 years apart, are vast. Sue was in a private room, and as many people who wanted to visit her could go at any time. Sue was able to talk to a minister during her time here, which I know really helped. Sue wasn’t able to eat or drink much, but if any of the patients wanted an alcoholic drink, they could have one. Sue’s dog was able to visit, as could her young nephews and nieces. I went into the hospice every day to see her. I knew she hadn’t got long, so I wanted to make the most of the time she had left. One of the nurses on the ward even came over and comforted me when they could see it was all getting too much for me to bear. They were absolutely fantastic, and I can’t thank them enough for how they were with Sue.

In 1962, mum wasn’t a person, just a death. The family who were left behind didn’t matter either. Fast-forward to 2017 and you can see everyone is treated as a person and their wishes are taken into account. There’s bereavement counselling for families and close friends. Everyone is well cared for. Even the staff on the reception desk are very helpful and kind.

It might have taken me until now to appreciate the real importance of hospice care, not just for the patient, but for their family and friends too. That’s why I’m going to support Ashgate in whatever ways I can.”

Our Care 29

Our shops and coffee shops are vital in helping to raise funds for Ashgate HospicecareRetail

Our 15 Ashgate Hospicecare shops and three coffee shops continue to provide a vital, unrestricted funding stream for the hospice, despite the challenging funding environment. Moreover, our shops and coffee shops enable the hospice to have a physical presence at multiple locations across North Derbyshire, which are key sites for interacting with our local community.

While mainstream retail continues to suffer, with many high street stores closing, the third sector continues to prosper. Most charity retailers, including the Ashgate Hospicecare shops, report an increase in sales.

This year, one of our aims for the shops was to break the £3 million turnover mark. We wanted to do this by growing donated income, improving our online

presence and developing our Ashgate Coffee Co. coffee shops. We not only achieved this aim but surpassed it. Income grew to a record £3,084,943, which brought in an actual profit of £865,167. All the sites made a profit.

This year, our Donation and Distribution Centre (DDC) in Hasland processed over 120,000 bags and boxes, turning these donations into saleable items. Our donated online sales also grew. With the collaboration of the DDC and our online experts, we were able to make sure that items of a higher value and interest were made available online.

Record-breaking year!

“The sale of donated goods makes the biggest impact on our profit. As a local charity, we are fortunate to have the support of our community. Ashgate Hospicecare holds a special place in the hearts of many local people. So, we must thank our community for continuing to donate to, and buy goods from, our shops.”

– Laura Stevens, Head of Retail Operations

Retail30

Our annual model store programme is still a key part of our strategy to improve standards and customer experience of our shops and coffee shops. It encourages our teams of retail staff and volunteers to sort merchandise into meaningful visual displays.

These help to improve customer experience in store, ensuring that customers will return again and again.

Always improving

The Charity Retail Association (CRA) is the only trade association and membership organisation representing charity retailers, large and small, across the United Kingdom. Our shops represent a small but important part of this group of 11,000 charity shops.

“My role with the CRA helps me to understand the bigger picture of charity retail and the challenges the industry is facing. It also means I can keep abreast of the important issues that may be affecting the local high streets and our shops.”

– Graham Richardson, Ashgate Hospicecare’s Director of Retail and Estates and CRA Board Member and Deputy Chair

Charity Retail Association

Retail

The sale of goods generously donated by the North Derbyshire community makes the biggest impact on our retail profits

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This year we will continue to refresh and refurbish our stores. This is an important capital investment that has made our charity retail stores both profitable and a positive touch point for the community. This year, we have already completed our Bakewell shop renovation. We are currently in the process of decorating our new coffee shop in Shirebrook, which is due to open in

Autumn 2019. The work of our Marketing, Digital and Communications Teams in showcasing retail through different mediums, online and offline, has helped to increase the number of donations we’re receiving, as well as footfall instore.

New shops and new looks

Sally and Stephen, our Coffee Shop Managers and their teams at Clowne and Hasland, strive to provide an excellent customer experience within our coffee shops. Thanks to their hard work, they have very quickly become an important part of the local communities they serve.

– Laura Stevens, Head of Retail Operations

Retail

Our Furniture Store at Hasland is home to one of our four Ashgate Coffee Co. coffee shops

We couldn’t run our shops and coffee shops without our fantastic teams of staff and volunteers

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“I became Shop Manager at the Ashgate Coffee Co. coffee shop in August 2016, ahead of its opening in the October. I wanted to work for Ashgate Hospicecare because my dad had not long since died. He wasn’t cared for by the hospice, but he was well cared for. It was wonderful to think that, by using my skills and experience, I could help people living with terminal illness and at the end of their lives. I wanted a challenge and, with this being a new venture for the hospice, I was keen to take it on.

We didn’t expect that, very quickly, our coffee shop would become an important hub for the Clowne community. I don’t come from Clowne, I’m from another part of Chesterfield. However, I was quickly embraced by the customers as a member of their community. I’m not exaggerating when I say that I feel as though everybody who comes through our doors becomes part of my extended family. When I pop to the supermarket around the corner, I can see as many as 15 people who are coffee shop customers! It’s such a close-knit community and it’s lovely to be part of that.

I feel as though I belong to Clowne now and I think that’s why it works so well. We take time to get to know our customers and have a laugh with them. One of the best things about my job is having the ability to plan events at the coffee shop that benefit the local community and that also raise extra funds for the hospice. We’ve hosted three seasonal fashion shows, which have all been really successful and well received. We sold out of tickets really quickly for those. We’ve done a harvest supper, Christmas and Easter craft fairs and a Santa’s Grotto. I’d like to plan more events and get as many different people as possible from across the community involved.

Of course, none of this would be possible without our dedicated team of staff and volunteers, who have also become part of my family. We’ve got a diverse group of volunteers and most of them come from Clowne or the surrounding area. This is not only nice for our

customers but has also meant that the coffee shop has brought new opportunities for those in the area who perhaps wouldn’t be able to get all the way over to the hospice to work or volunteer.

It’s great to see our staff and volunteers develop here. One of our youngest volunteers, Jasmine, was awarded Young Volunteer of the Year at the Chesterfield Voluntary Sector Awards in October 2018 at the age of 17. It was so well-deserved since she’s always keen to help us whenever she can. That’s what I mean, we just have an excellent team. It can be hard work when the coffee shop gets busy, but we all enjoy being here.

Working at the Ashgate Coffee Co. is very special because, as well as being a place for the local community, all the profits raised go to ensuring that our specialist nurses and healthcare assistants can continue to care for patients and their families across North Derbyshire. We’re also raising awareness of the work that Ashgate Hospicecare does for those who may not know. People often ask me questions and we’ll have a conversation about the hospice and what services it provides.

One customer told me that, when her husband was on the Inpatient Unit at Christmas time, the staff decorated tables for them and gave them both a glass of wine, which she thought was a lovely touch. She said, ‘It was as if we were at home. He couldn’t have been happier or more comfortable.’ I love hearing those stories because they remind me of how important are the funds we raise.

I get so much satisfaction from working here. A customer said to me the other day, ‘Do you know what, Sally, this place is the best thing that’s happened to Clowne, and you’re the best thing that’s ever happened’. She said, ‘Keep doing what you’re doing because it’s brilliant!’. It’s so humbling to hear feedback like that.”

Sally’s StoryAshgate Coffee Co. Clowne Manager

“I feel as though everybody who comes through our doors becomes part of my extended family.”

Retail

Sally has been managing the coffee shop in Clowne since it opened three years ago

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Spotlight on our Rowsley Shop

“Our Rowsley Shop opened in April 2017 when the beautiful Old Station Building in Rowsley

became available. We can give people a different shopping experience here as we’ve got the Vintage

Room, the Gent’s Room, a craft section and we’ve got space for bigger items, like old suitcases and chairs. We’re able to get good quality products for our customers. It’s a

hidden gem in Rowsley!”

Sophie, Shop Manager

“ I’ve been volunteering at the shop for a year, doing three or four hours a week when I can. I can’t always do a regular shift because I have a part-time job, but the staff here are very good about that and they allow me the flexibility I need. It’s a stress-free bit of volunteering. Tea’s always plentiful and sometimes you walk in the door and the first thing Sophie says is, do you want a tea? I’m thinking, you must be far too busy to make a tea for us, but she does!”

Maria, volunteer

“I’m one of the newest members of the team. My father was cared for by a hospice in Wakefield, and the staff there were amazing with him. That’s why I wanted to do something locally for a hospice and so I came to the Rowsley Shop. I don’t think you really understand the need for hospices until you’ve been in that situation yourself.

When I started, I was really nervous about using the till and computer I don’t use a computer at home, but I never feel worried if I make a mistake since there are always people around whom I can ask. I’ve had customers who’ve had family cared for by Ashgate which is nice because it reinforces why we’re here and where the money we raise is going. Not everyone can give money regularly to Ashgate, so they choose to donate to the shop or come and shop here. That’s their way of giving back and staying connected.”

Diane, volunteer

Volunteer Kathryn kindly gives her time to helping in the Rowsley Shop

Secret Vintage Room “I know that the care Ashgate gives is absolutely

fantastic. When I stopped working, I needed something just to get out one day a week and I

wanted it to be fun, so I applied to volunteer here. And, honestly, this couldn’t be more fun! I really look

forward to my day here. I get to dress up and help out in the Vintage Room. I rarely come here without

buying something for my own collection!

I think people are more concerned about reusing and recycling nowadays, and it’s nice to know that this

shop can help them to do that. ‘Make do and mend’ is back in fashion! There are a lot of people who follow

vintage trends and so it’s great that this shop has managed to tap into that. You can find some really

lovely things in here.”

Kathryn, volunteer

Retail

Visit our Rowsley Shop to discover treasures in our Secret Vintage Room

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What’s Next - Retailing in 2020 and onwards

In order to ensure the success of our shops and coffee shops, we need to keep up-to-date with the retail market in our area in order to anticipate future opportunities and challenges. Keeping connected to local community projects and initiatives is a crucial part of this. We shall be carrying out market research to help inform us of our local commu-nity’s needs, the results of which will help to shape our retail strategy.

As Ashgate Hospicecare approaches the start of a new five-year strategy, we shall be looking at all our shops and coffee shops in line with our new strategic priorities. This will include a review of our physical trading spaces and the purposes for which we use these spaces. We shall also continue to review our local high streets as part of a for-ward-thinking strategy in order to be part of this change.

Retail

We launched the Ashgate Furniture Co. two years ago which gives customers the option to buy new goods in store and online

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Our People

Our PeopleThis has been a year of consolidation and review of the way we work at Ashgate Hospicecare. We’ve had the opportunity to reshape our systems to ensure a sustainable future.

What we’ve achievedLearning and Organisational Development

As one of our priorities to measure and improve outcomes for the patients and families we support, we have reshaped our Learning and Organisational Development Team and reviewed the training provision for all staff and volunteers. This will ensure that we continue to improve the care we provide and that each member of our workforce can reach their maximum potential. The role of this team is also to enable our people to transform the systems they work in, empower our workforce and give people ownership over their roles. This will result in more efficient and effective working practices with greater staff and volunteer satisfaction and engagement.

This year, our priority was to appraise our training provision, with a particular emphasis on our Inpatient Unit Team, to ensure that we can meet the future demands of specialist palliative care for our patients. We introduced Essential Training and JSET (Job Specific Essential Training) with the aim of improving effectiveness and efficiency of training provision. This has resulted in staff and volunteers making more effective use of their time in training, as well as attending training programmes specifically tailored to the demands of each service. We also aim to maximise the use of apprenticeship levy funds.

We have appointed a part-time clinical educator dedicated to working with the clinical teams, including the Supportive Care Team. This appointment will focus on upskilling our workforce so that Ashgate Hospicecare can continue to provide timely, responsive and high-quality palliative and end of life care, both at the hospice and in the community. This has helped to widen the capacity of the specialist services we offer. This enables us to keep up with the increasing demand on our services, due to increasing numbers of patients with complex needs and multiple morbidities. This role will link with Higher Education organisations, meaning that we shall be able to facilitate more student placements. Furthermore, we are now able to offer much more training on site, saving the hospice time and money.

We will continue to monitor the outcomes of our training provision, responding to the demands for our services as well as the needs of our people. This is with a view to developing career pathways and retaining talent in order to meet future workforce needs. We know that learning and development opportunities are an essential part of our employee value proposition (EVP). They become increasingly important as we seek to attract and retain clinical, non-clinical and retail staff and volunteers in an increasingly competitive market.

Our Commitment to Our People

We have been successfully revalidated as a Mindful Employer and maintain our status as a Disability Confident Employer, working towards achieving the Disability Leader status in future as part of our Equality, Diversity and Inclusion agenda. As part of our ongoing commitment to being a Dying To Work Charter signatory, we introduced a new policy commitment for any employee with a life-limiting condition, ensuring their employment rights and associated benefits are protected. We also continue to work closely with the TUC in the provision of training to other employers to help ensure those with life-limiting conditions in all industries are protected.

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Our People

Collaboration with Blythe House

This year, we have collaborated closely with Blythe House Hospicecare, which covers the High Peak area of North Derbyshire. As part of this collaboration, Ashgate Hospicecare has been working to develop Blythe House Hospicecare’s human resources department. This is a win-win for both hospices. It provides extra income to Ashgate Hospicecare and improves the quality of Blythe House Hospicecare’s systems to ensure that the best care is being provided in the High Peak.

Volunteers

Our volunteer numbers continue to grow, along with demand for our services. Ashgate has 700 volunteers who offer their skills and support across all areas of the hospice including patient care, retail and fundraising. The monetary value of the hours of volunteering which they gave to the hospice represented at least £500,000 in 2018/19, and that contribution continues to grow. They are a vital part of the team and the hospice would not be able to provide services without them. We are extremely grateful for their work and support.

We recognise that every area of the hospice can benefit enormously from the support of skilled and motivated volunteers. Consequently, this year we

focused on placing volunteers into the right roles for them and worked with staff to support volunteers to get the most out of their roles.

We know that our dedicated volunteers play an integral role in improving efficiency within teams. They increase the capacity of the services we offer to patients and their families. Moreover, the money saved thanks to the time our volunteers dedicate to the hospice, means that we shall have more funds to spend on patient care. Looking to the future, we shall work to ensure that all teams across the hospice feel fully supported by great volunteers and that our volunteers are getting the most out of their roles.

Technology and Digital

This year, we underwent a strategic review of our IT infrastructure and made changes with the aim of providing safe, high-quality and responsive services. We recognise the need to invest in IT that improves efficiency in clinical and non-clinical areas. For example, we shall be rolling out new hardware and software across the hospice, including technology that will enable our community nursing teams to work remotely. This will mean that staff won’t have to come back to the hospice to type up patient notes. They will therefore be able to see more patients in their day, increasing the capacity of our community services. Furthermore, we now have 24/7 IT support for the Inpatient Unit Team, as well as extra IT support on site for all staff in order to resolve issues quickly.

We are utilising available technologies effectively to monitor and improve the quality of the care we provide. This year, our two End of Life Care Facilitators launched Project ECHO which harnesses the latest video conferencing technology to deliver education to care organisations out in the community. This project has received excellent feedback and has already been shown to improve the quality of palliative and end of life care offered in places such as nursing and care homes.

Our Receptionists are the friendly face of the hospice for our patients and families

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#LetsTalkInclusion

This year we launched our new programme of events and education under the name #Let’sTalkInclusion as part of our work to recognise and reflect the diversity of our local communities. We have been fortunate to benefit from a number of prominent figures from diverse backgrounds. They were generous enough to share their insights and expertise with our staff and volunteers.

The speakers included John Yates-Harold from Derbyshire LGBT+. Following John’s workshop, Gina, who works on our inpatient unit as a healthcare assistant, designed an Ashgate Hospicecare rainbow badge to show our pride in working with the Lesbian, Gay, Bisexual, and Transgender ( LGBT+) community. Staff and volunteers have to complete our equality and diversity training before they are able to wear this badge and it has been very popular.

We were particularly pleased to hold early meetings of the newly established Ashgate Hospicecare LGBT+ network. The network is intended to offer our LGBT+ staff and volunteers, and their allies, a safe and welcoming space to explore their experiences working at the hospice. It is also to help us improve the care we provide for LGBT+ patients and their families.

We also benefited from an educational talk about the

local Muslim community from Farooq Sadiq. He was kind enough to invite a number of staff and volunteers to visit the mosque in Chesterfield, when attendees broke their fast during Ramadan. Doctor Chris Hewer, a theologian, gave a presentation about the basic tenets of belief in Islam to ensure that we are more able to care for Muslim patients who need our care.

We wanted to reach out to the homeless community and were delighted to establish a relationship with Lighthouse Homes in Sh