Transforming End of Life care in Surrey

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Our team today

• Nigel Harding Chief Executive• David Perry Chairman• Rachel Hill Director of Clinical Services• Dr Fiona Bailey Medical Director and Consultant in

Palliative Medicine• Pam Walmsley Deputy of Clinical Services• Shelagh Musoke Clinical Nurse Specialist and SBH Community Team Lead• Helen Bryant Ward Manager, SBH• Liz Bennett Day Care Leader, SBH

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Sam Beare Hospice - history• Hospital on current site built in 1927 and there has been a Sam

Beare palliative care ward since the mid 70’s• In 2005 PCT asked for proposals for the future management of

beds • Princess Alice planned closing the unit - Woking Hospice

proposed on-going ten bed in-patient Hospice with outreach services and took control in 2006

• PCT support was provided but reduced over time – the deficit was not met by fundraising

• 2008 – ‘Keep the Doors Open’ Hospices campaign to fundraise • 2013 announcement of plans to re-locate in-patient beds in

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Demographics: Total number of patients

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Growing need for Hospice care • 39% increase in the number of patients admitted since 2011

• 20% increase in patients referred to our Community Teams since 2011

• 7% increase in attendances to Day Care

• 20% increase in non-cancer referrals in the last two years

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Pressure on care services expected to increase

• Annual mortality rate is set to rise by 2016

• People are living longer and more likely to have chronic diseases with greater complexity

• The number of people living with cancer will increase

• By 2021 over 1 million people will be living with dementia

• Projected 135% increase in population aged >85 by 2033

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Sam Beare - facilitiesWe are proud of the performance of the unit and the positive 2013 report from the CQC is testament to our staff. But;• It is integrated within Weybridge Hospital - not purpose built

and only accessed through a pharmacy and waiting room • Public access to reception, offices and to day-care is only

possible past (often) open patient rooms• Nurses and volunteers have to battle to maintain patient and

family privacy and dignity• Rooms not large enough for some patient/family needs• Patients share one bathroom as there are no en-suitesIn short, it is not the ideal environment for modern palliative care.

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Planning for the future• Against this background we conducted a detailed review and

produced a challenging Strategic Plan for the Hospices. There were two key recommendations to:

• reshape the organisation, moving to a single, 20 bed in-patient unit

• create two centres of excellence in Day and Community care at the Sam Beare and Woking Hospices

• A loan from Woking Borough Council enabled the Hospices to act quickly on these recommendations

• Announced in November – public meetings held in December 2013

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Our future care services• Hospice at home

• Community Clinical Nurse Specialists

• In-patient care

• Day care units – Community Hubs

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Community HUB

Psychological Therapies Counselling Music/Art

Oncological Outreach Therapies

Additional Services: Hairdresser Bathing Chiropody Beauty treatments

Drop In Centre Resource / Information Welfare Advice Computer access Clinical Nurse Specialist avaialbe Duty Clinical Nurse Specialist available

Cafe Light refreshments Volunteer run

Base for: Doctors CNSs OT Physio Counsellors Admin

Outpatient Consultants clinics Nurse led clinics Therapist clinics

Carers Group

Therapeutic Models Educational programmes Complementary therapies Art / music therapies

Respite 5 days a week Focus to keep patients at home

Focus work for non-cancer patient care bundles

Medical Interventions: - blood transfusions - intravenous therapy

Education delivery to HCPs

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Sam Beare Hospice

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Sam Beare - finances

• 2009-12 income broadly matched expenditure but costs rising and eating into reserves

• Projected income will not cover future costs – operating loss of £ 217k forecast for this year and a similar result expected next year.

Costs rose significantly in 2012 due to:• the implementation of CQC recommendations regarding the

need to bolster training, HR and educational provision• the transfer to the Hospice of former NHS staff costs• transfer to the Hospice of porterage and catering costs

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Sam Beare - finances

Total forecast deficit by March 2015 = £222k

Finances stabilised in strategic plan through re-location of in-patient beds and creation of best in class day-care facilities

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Sam Beare - finances

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Comparing usage to giving:

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Sam Beare – future options

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Options

Note: There is no certainty of a lease extension at Sam Beare

We cannot continue with the 10 bed in-patient facility or reconfigure for a 5 bed facility.

The 10 bed provision prevents us from providing the highest standards of modern palliative care. Both are expensive options which are not considered viable in long term.

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Preferred optionRelocate all in-patient beds and reconfigure the building to create a centre of excellence in Day and Community careWhat would need to change?• The granting of an extended lease (due to end in 2015)• Reconfigure building, relocating the reception• The creation of new improved facilities, increasing capacity

for Day and Community care and support• Permission of NHS estates and full support of CCG• Continued strong community support• Circa £100k capital investmentThis is the preferred option as announced in November 2013

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Possible option Relocate Sam Beare and establish a new in-patient facility and Day and Community Care centre of excellence in the area.What would need to happen?• Possible granting of an extended lease (due to end in 2015)• Identify a building in the area suitable for conversion• Full support of CCG• Philanthropic individuals prepared to cover purchase and

conversion costs c.£3m• Increased, on-going community support of c.£0.5m to cover

additional costs of independent HospiceOption being investigated and sites visited. May be viable but certainty of short and long term funding needed.

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Next steps Next steps:• Negotiate and confirm lease extension beyond 2015• Develop strategy announced in 2013 – creating a new 20 bed

in-patient facility to open in Woking in 2016 (relocating inpatient beds from Sam Beare) and creating two centres of excellence for Day and Community Care

• Investigate and review possible option of relocating• Listen to and provide regular progress updates to all

stakeholders

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Transforming End of Life care in Surrey

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