Our Vision

Background

Since 2015 St Margaret’s Hospice has been reviewing every aspect of end of life care. Through the Fit for Future review, there was engagement with the Somerset community, end-of-life care experts and representatives of local healthcare organisations, including other charities and NHS colleagues across the county, to review the services we provide to patients and their families. This review identified six key challenges:

  • Finance/Funding
  • Rising demand
  • Maintenance of quality
  • Fractured services
  • Accessibility and equity
  • Maintaining and developing the workforce.

Since Fit for Future we have been working to address these challenges. We have been investing in our staff and developing how we work with and support others in the county, who are providing care for people approaching the end of their lives. We have invested in our community nursing teams, increasing the number of staff working across the teams to start to provide a 7 day community service. Non-medical prescribers are now part of the community specialist nursing teams and Project ECHO commenced in 2018. Care homes across Somerset have been getting involved in ECHO, learning from clinical experts and each other while sharing case studies using video-conferencing technology. They are very positive about the impact this has had on the care they provide.

However, the challenges we face in delivering end of life care to the whole community are considerable.

On the 31 July 2019, St Margaret’s Hospice Care announced a proposal to remodel its services to address the challenges that we, like so many other hospices across the UK, are facing.

With over 5,500 people dying in Somerset each year and an estimated 4,000 plus who would benefit from hospice care there is a growing gap between those we help and those we are currently unable to provide support to.

This document sets out what the new clinical model for St Margaret’s will be, ensuring that Hospice Care is Fit for the Future.

Providing palliative care and end of life care closer to home, while ensuring specialist care is available for those who need it across Somerset, is a key component of St Margaret’s Strategy.

How we will provide care and support in collaboration with others

The new clinical model will enable the teams to support patients and families in the community in a more proactive way, being able to plan care in advance with patients in their own homes about what their future needs might be.  We will increasingly working alongside NHS and adult social care community teams to anticipate and prepare for the changing needs that our patients may have. More hospice community staff, working each day of the week, will have the satisfaction of knowing that they are actively supporting more patients and families to have peaceful end of life experiences at, or closer to home.

While much of the community investment will be concentrated on East and South Somerset, there will be some additional investment in community hospice services across the county and further support for the 24 hour advice line.

In-patient services will remain a key component of St Margaret’s Hospice Care and by bringing all our beds together on one site, the ongoing challenge to maintain sustainable staffing with appropriate skills, particularly specialist medical staffing, are reduced. Admission to the In-patient Unit will be assessed by need and will not be geography based. There will be opportunity for nursing staff to further develop their specialist clinical skills, enabling them to take a more proactive role in the clinical management of patients with increasing clinical complexities.

Community services

Our existing community service which includes specialist nurses, therapy and medical staff will be extended further to include an additional four full time equivalent registered nurses and four additional Multi-Disciplinary Team Assistants. These additional staff will support patients and families at home, via the advice line, in care homes and community hospitals across seven days per week.

Feedback and concerns from our patients, staff, volunteers and the general public was that the additional community support detailed in the original proposal did not go far enough. Our board of trustees have listened to this concern and have agreed to double the additional community staffing that was originally proposed, as detailed above.

Hospice clinicians will be available to provide both planned and unplanned visits and care to patients in the community, enabling more patients to remain at home for symptom control and end of life care. The extended team will work closely with other hospice teams, the NHS end of life coordination centre, district nursing, domiciliary providers, rapid response teams and community and acute hospital teams, encouraging a collaborative and truly integrated approach to care in this area.

Registered Nurses coming into the community team will have the ability to use their end of life skills to provide more personalised care to enable people to safely remain at or closer to home, regularly assessing pain and other symptoms to support prescribing and management plans. This will support GP and district nursing teams in their local communities.

This equates to 16 full time Registered Nurses and 10 full time Multi-Disciplinary Team Assistants with 14.6 Community Nurse Specialists working across Somerset.

Hospice Hub

Yeovil Hospice Hub (Monday to Friday)

Taunton Hospice Hub (7 days a week)

Day hospice services, rehabilitative therapy, carer respite

Day hospice services, rehabilitative therapy, carer respite

Adviceline

24 hour adviceline

Outpatient clinics

Outpatient clinics

Community team and response service

Community team and response service

Spiritual Care

Spiritual care

Complementary therapy

Complementary therapy

Physiotherapy

Physiotherapy

Psychotherapeutic support

Psychotherapeutic support

Occupational therapy

Occupational therapy

Social work

Social work

Lymphoedema service

Lymphoedema service

Bereavement counselling services

Bereavement counselling services

Family support services

Family support services

Carer support groups

Carer support groups

ECHO hub

ECHO hub

Education services

Education services

Ongoing community resource

Ongoing community resource

Community event space

16 bed specialist In-patient Unit

Telephone bereavement support

 

The safest and most sustainable way for us to deliver the specialist care required for those patients with the most complex end of life care needs in Somerset has meant consolidating all of our specialist beds on one site. It is hoped that we will be able to bring the best of both In-patients Units together in one team.

Going forward we are committed to increasing the specialist skills of the nursing staff working in the In-patient Unit to better support patient care, increase symptom management while developing nursing careers. Following feedback from staff, our board of trustees have agreed to increase this resource to develop two advanced nurse practitioners within the hospice In-patient Unit.

Wider county developments

St Margaret’s have been actively involved since 2015 with the Somerset Sustainability and Transformation Programme and the development of the county’s end of life care strategy. This has been to ensure it is seen as a priority across all of health and social care in Somerset and not just the charitable sector.

Community Hospital Beds

Two community beds will be ring-fenced for patients with more complex end of life care in the South Somerset area who may not wish to travel to Taunton. St Margaret’s Hospice Care staff will work with the Somerset Partnership NHS Trust Palliative Medicine Consultants to provide support to community hospital staff including planned and unplanned medical, nursing and therapy support with access to our 24 hour adviceline.

End of Life Rapid Response

There has been investment from NHS England to create a rapid response team for end of life care patients in Somerset. St Margaret’s will be actively involved in shaping this service, providing assurance and safety for families who are concerned about caring for end of life patients in their own homes. This encapsulates the Fit for Future strategy, bringing care closer to home, working collaboratively with our healthcare partners.

Financial Sustainability

Whilst this has not been an easy decision to make, we believe this was the brave and proactive one to make. It is a necessary course of action for all hospices to ensure they are here for the future. We believe the action we have taken will ensure a sustainable future for St Margaret’s Hospice Care, rather than reaching a crisis point which other hospices have faced when their reserves have already been depleted.

St Margaret’s Hospice is one charity for the people of Somerset, caring and supporting patients and their families and carers. While care will be different, this decision supports St Margaret’s Hospice Care, along with the wider healthcare community in reaching more people who will benefit from our help and support, in the months and years to come.








 

 

St Margaret's Somerset Hospice. Copyright © 2019 Registered charity number: 279473 Company limited by guarantee number: ENG 1471345. All rights reserved.
Registered Office: Heron Drive, Taunton, TA1 5HA

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