September 2012 Registered Charity No: SAINT FRANCIS HOSPICE CURRENT STRATEGY AND WORKING WITH CCGS 1 Pam Court, CEO

VISION Registered Charity No: A community where everyone receives excellent palliative and end of life care, when they need it and in the place of their choosing Saint Francis Hospice doing more than you think. 2

SAINT FRANCIS HOSPICE Provider of Specialist Palliative Care for: Havering Barking & Dagenham Brentwood Redbridge (Inpatients & Day Hospice only) West Essex Borders – Stapleford Abbots, Ongar and Abridge 3

SAINT FRANCIS HOSPICE - continued Services Provided: In Patient Care – 18 beds Day Hospice Community Palliative Care Services (24/7) Triage Hospice at Home (24/7) Therapies including Complementary Therapy Spiritual Care Family Support Services Bereavement 4

SAINT FRANCIS HOSPICE - continued Services Provided – continued Education In house mandatory training External generalist and specialist Palliative Care Advanced Communications Specialist i.e. East of England Ambulance Trust Redbridge Care Home 2 Day Course – Introduction to Palliative Care and Dignity and Choice 5

EXTERNAL CHANGES NHS Structural reform including the abolition of PCTs, the move to Clinical Commissioning and greater involvement of local authorities in healthcare issues. Creation of a mixed market in healthcare provision leading to increased opportunities for private companies and social enterprises formed by existing NHS employees. 6

EXTERNAL CHANGES - Continued A national review of palliative care funding that may lead to tendering for contracts to provide end of life care over a much broader range of services than we currently provide. This may necessitate the formation of formal partnerships with other organisations. Move to National Tariff 2016 Significant demographic changes, including an aging population and associated changes in the way people are dying, including a reduction in deaths from cancer and increased incidence of dementia and those living with multiple chronic conditions. 7

EXTERNAL CHANGES - Continued A challenging economic environment causing a downturn in our voluntary income which has accelerated in the long term financial trends and caused us to move into an operating deficit. Self Directed Support and Personalised Budgets These external changes may require a future review of our existing Vision as a provider of solely specialist palliative care and our relationship with the NHS/Local Authority/Our Communities. 8

COMPETITIVE MARKET Finance currently 40% NHS, 60% Fundraising will it go up and/or down Move to Clinical Commissioning Groups Risks/Opportunities Fundraising/Shops Risks/Opportunities 9

ASSUMPTIONS Number of deaths increase Complexity of care likely to increase Non Cancer patients likely to increase BMI and hard to reach groups to increase Public want choice Requests for community services likely to continue to increase Are people more likely to want to die at home? 10

PUBLIC VIEWS ON END OF LIFE 70% of people want to die at home, but more than 50% die in hospital. 59% are scared of dying in hospital 71% do not discuss end of life plans Only 41% write down their wishes 11

PROJECTIONS Deaths due to rise 17% by 2030 Dementia will rise from 822,000 to 1 million in 2025 There will be lack of capacity in hospitals and hospices which will increase the demand in care homes, supported housing and home deaths 12

KEY ISSUES FOR REDBRIDGE END OF LIFE CARE Increase in the number of people dying at an older age and complex mobility's Number of Redbridge deaths have increased and need to continue to increase to meet the national average End of Life seen as a local priority Redbridge come together with the four other boroughs to share knowledge and expertise on EOL Care 13

KEY ISSUES FOR REDBRIDGE END OF LIFE CARE Outer NEL is currently in the lowest 20% of PCTs on the quality of care for EOL (11 indicators 9 red 2 amber) Action Plan for Redbridge already in place Saint Francis Hospice closely working with all other providers and commissioners to improve services for Redbridge Care Home Programme for this year in place Very poor uptake of GP End of Life programme (had to cancel this year) would welcome feedback. 14

KEY ISSUES – REDBRIDGE Only provide In Patient and Day Hospice services Usage of beds and day hospice have been significantly down over the last 2-3 years – activity now rising. SFH does not provide Community Service/Hospice at Home or Triage service Redbridge Palliative Care team limited to Monday to Friday 9-5pm Fundraising very low; 1 shop although planning in place MacMillan have high profile. District/Community Nurse coverage out of hours not yet across full 24 hours. 15

REDBRIDGE ACTIVITY 2011/12 SLAActual Outturn Inpatient Beds Day Hospice

KEY ISSUES FACING THE HOSPICE Saint Francis Hospice – high quality provider with good reputation Income below expenditure – not sustainable Referrals up across all services – particularly community, staff resource can not be stretched further Liaison with Commissioners was established – re-organisation caused difficulties, need to form relationship within emergent clinical commissioning groups 17

KEY ISSUES FACING THE HOSPICE continued Fundraising doing well but is it sustainable? Charity sector very competitive Co-ordination of providers across End of Life and Palliative Care – seems more difficult Funds and Communication for End of Life Education need NHS and Care Home commitment To provide 24/7 Community Services need 24 hour District Nursing care and support of Marie Curie 18

NEW STRATEGY FOR SFH Remodelling of Community Services to provide complete 24/7 care including a Rapid Response Team (currently not for Redbridge). To work collaboratively with Redbridge providers to ensure 24/7 community care is in place To be an education provider of choice – hoping to be a GSF provider for the region (awaiting to hear final decision) To reach out to diverse communities To promote volunteering (350 staff/800 volunteers) To increase fundraising market in Redbridge – hoping to acquire a shop in Ilford Hoping to be the highest quality provider of choice for our communities for EOL Care. 19

ANY QUESTIONS 20