Dorothy House Hospice Care Annual Report and Accounts 2014/2015

Dorothy House Hospice CareAnnual Report and Accounts 2014/20152 Welcome from the chair3 Mission3 Vision4 Our Work6 Patient Care7 Lachmi Bose and Piu’s story8 Caring in the Community10 Part of the Community12 Dying Matters Art Exhibition Case Study13 Opening the Dorothy House Purse14 Income Generation15 Dorothy House in Numbers16 Independent Auditor’s Report18 Aims for the Year Ahead20 Message from our Chief Executive1 Welcome from the ChairDear friends, volunteers, partners and staff.It is a great pleasure to introduce this report of the work of Dorothy House Hospice Care (DHHC) for 2014/2015.Every year is a busy one but last year particularly so as DHHC delivered even more care in our community. We are passionate about our work in the community which also supports the efforts of GP practices and acute trusts to provide greater patient choice, avoid hospital admissions where possible and encourage earlier discharge from hospital.Last year we developed a wider and deeper rehabilitation programme for patients and increased access to our services from our Outreach Centres in Peasedown St John and Trowbridge. Providing excellent compassionate care to our community is the bedrock of our work.This year has seen some key changes at DHHC such as the appointment of Chief Executive John Davies, and other new personnel who bring with them energy and passion to the organisation. On behalf of the Board of Trustees, I am delighted that this Annual Report not only details our financial activity and highlights from last year but, with these organisational changes, gives you a chance to hear more about our direction of travel for the future.As I make way for a new Chair of Trustees, Kate Tompkins, I would like to thank you all for your hard work, support and dedication to DHHC over the last year. I wish Kate, John and the team every success and I know that DHHC will continue to inspire all those it touches with its tireless work in the community.Simon CoombeChairman2 MissionTo work with our community to develop, influence and provide responsive palliative and end of life care that meets the needs of all people with a life-limiting illness. We strive to be an inspirational leader, empowering our community, encouraging future generations. Our purpose is to ensure the very best care is provided wherever and whenever it is needed.VisionCompassionate caring for our community, supporting people with life-limiting illness to live well and die well.“YOU MATTER BECAUSE YOU ARE YOU, AND YOU MATTER TO THE END OF YOUR LIFE. WE WILL DO ALL WE CAN, NOT ONLY TO HELP YOU DIE PEACEFULLY, BUT ALSO TO LIVE UNTIL YOU DIE.”(Dame Cicely Saunders 1918 -2005)3 Our WorkDorothy House Hospice Care (DHHC) provides excellent, compassionate care across a region of 700 sq miles, serving a population of 550,000 within a complex and ever-changing health and social care system.DHHC was established in 1976 and next year we will be celebrating out 40th Birthday. Over the years we have developed and expanded to offer a wide range of services and education in specialist palliative care.We provide services to help our patients; their families and carers live each day to the full and to ensure, where possible, the best quality of life. We provide respite care and care for patients in the last stages of life through to death and we help families and carers, adults and children, both pre-and-post bereavement.We are developing ‘lighter touch’ methods of support for those individuals with a life-limiting illness who may not have complex needs requiring specialist palliative care intervention, but would still benefit from our support and experience. This is also extended to a patient’s family and carers.All DHHC professionals work very closely with local health and social care teams to enable patients to remain in their preferred place of care and to live their lives as fully as possible. Part of the support we offer is a 24hr Advice Line available to health and social care professionals, patients, their families and carers, providing round the clock advisory support.All health and social care staff are supported in their professional development and updated in their knowledge of palliative care by DHHC Education and Training Team. The team also offer a range of educational programmes to enable colleagues working in health and social care throughout our community to increase their knowledge and understanding of caring for people with a life-limiting illness.Most of the work of DHHC is delivered within the community that we serve and the majority of care is provided for patients, their families and carers in their own homes, community hospitals, nursing and residential homes.We have an Inpatient Unit at Winsley and also offer services in two Outreach Centres, located in Trowbridge and Peasedown St John. In addition, the DHHC Medical Team provides consultative sessions to the Royal United Hospital, Bath.4 8 THINGS YOU SHOULD KNOW ABOUT YOUR HOSPICE ...1. Dorothy House Hospice Care is an independent charity and our services are available free of charge.2. We provide excellent, compassionate care in out community, supporting people with life-limiting illness to live well and die well.3. We are committed to supporting families and carers for as long as it takes.4. We cover an area of over 700 sq miles and the majority of our care is provided in the home and the community.5. We enable health and social care professionals to deliver excellent, best practice palliative care through our education programmes.6. We work closely with over 1,000 volunteers to achieve the best experience for everyone.7. For every £1 from the NHS, we have to raise £4.8. Using innovative services and 24/7 support we provide an alternative to hospital care and help save the NHS money.5 Patient CarePatient Care, whether Inpatient, Day Patient or out in the community, is the focus of all our effort. It is becoming more complex; lengths of stay within our Inpatient Unit are longer and the percentage of non-cancer patients being supported by our teams rose from 16% to 20% last year. We cared for 3,000 patients and clients during this reporting period, delivering 396 medical consultations outside the Hospice and in the community.Understanding what we get right and what we can improve on is fundamental to us. Last year we initiated real time patient and customer feedback to ensure we deliver the highest level of care, which is relevant and responsive.20% Non-cancer patients | 3,000 patients & clients cared for | 396 medical consultations outside the hospice“THIS IS A LOVELY PLACE, STAFF ARE PROFESSIONAL, CARING AND UNBELIEVABLY KIND. EVERYTHING IS CLEARED TO MAKE THINGS EASIER FOR PATIENTS AND RELATIVES.”6 Lachmi Bose and Piu’s storyMy husband was diagnosed with mesothelioma and his oncologist gave him 2-3 months to live, as it is a very progressive illness. Jagadish told us that he didn’t want to go to hospital, or be in a hospice, he just wanted to be at home with his family.At first I was trying to do everything myself, but after a couple of weeks I was exhausted, having been up 24/7 and still working during the day. I got to the stage that I couldn’t think or even see clearly and at that point I knew that I needed to ask my GP for support. This wasn’t an easy decision because I felt guilty. I felt I could and should be able to do it all.Asking for help from the GP was a turning point and this was when Dorothy House Hospice Care got involved.Mu husband was allocated a Nurse Specialist and I was so grateful for this support. She was like a soothing balm, so gentle and kind, and when she was around my anxieties would just disappear.The Hospice at Home carers started to provide the care through the night, which meant I could get some sleep. It was a great comfort to me that someone who didn’t even know my family would come and sit beside me so that I wouldn’t have to face his death alone.The Dorothy House team has such immense experience and draw upon that to help you understand what is happening and what is best to do in particular circumstance.My daughter Piu, was so relieved that Hospice at Home was helping to support the burden that his rapid decline created.“For Mum, those couple of months were physically and emotionally exhausting. It was such a relief to know that when I left the house, Mum was not alone and support was there for her.We also always knew that Dorothy House was only a phone call away, no matter how small the question. Until you are in the situation when you rely upon the care Dorothy House offers, you cannot comprehend how important it is. It was a lifeline for Mum and our family.Hospice at Home enabled Jagadish to die at home and have a good death. In Dorothy House I have witnessed the amazing face of human kindness and I am a better person for it.“HOSPICE AT HOME ENABLED JAGADISH TO DIE AT HOME AND HAVE A GOOD DEATH”Hospice at Home carers delivered 18,366 hours of care (2,300 shifts) across our 700sq mile area7 Caring in the CommunityIn 2014/2015 we expanded out Hospice at Home capability by a third, enabling us to support many more patients. This has also helped in our aim to allow patients to choose where they die.In response to winter pressures on the NHS and in partnership with Medvivo, Prospect Hospice and Wiltshire County Council, we successfully delivered a pilot 72 hour ‘Rapid Response’ service for end of life patients in the Wiltshire area. This helps the NHS to prevent unnecessary hospital admissions and support earlier discharge from hospital. The service also ensures that at the end of three days, there is a clear plan in place for ongoing care of the patient.From launch in November 2014 to April 2015 we cared for 34 patients in Wiltshire who, otherwise, would have had to remain in hospital. The pilot has been so successful that the service has been extended to the end of 2015/2016 and is now embedded in the Wiltshire County Council ‘Home First’ programme.In June 2014 we launched our Community Lodges at Winsley, which are a home-from-home environment, providing patient and carer respite for a week. We have cared for 51 patients through this initiative during the reporting period.2015/2015 has seen the following: Our adult social workers have made 1,041 contacts with patients, carers and familiesOur Children and Young People’s service has worked alongside 746 patients and clients8 Helping with family life58 year old Sue* has a terminal brain tumour and lives with her husband. Both her daughters are at university, the eldest of whom was due to perform at the Edinburgh Festival Fringe last year. Around this time Sue’s health began to deteriorate and it was clear that she would be unable to watch her daughter perform. Her husband was anxious about going to Edinburgh and leaving his wife.Following discussions with the DHNS (Dorothy House Nurse Specialist) who was supporting Sue, and with the family and community teams, it was agreed that the younger daughter would remain at home with Sue along with support from Dorothy House 72 hour carers. The necessary referral to this service was made that same day along with plans for a care package after 72 hours. Although Sue was deteriorating rapidly and a syringe driver was commenced, her husband was able to fly up to Edinburgh for the day, see his elder daughter perform and return with her, safe in the knowledge that Sue had round the clock care.Over the 72 hours Sue started to respond well to the medication and at the end of this period, she and her family were able to manage without external support. Sue currently attends the Day Patient Unit at Winsley.* Name has been changed9 Part of the CommunityThrough our outreach services, we aim to encourage caring communities, companionship, patient resilience and independence.Reaching OutWe have designed and delivered a range of new community initiatives within our outreach services, defined as “innovative and brave” by NHS England. These include a Coffee Club for patients, carers and bereaved, Tea@3 ( drop-in bereavement support), a ‘Plot to Plate’ gardening group, Sewing Bee group and a ‘Cook, Share, Eat’ group.Our Outreach Centres at Peasedown St John and Trowbridge have seen 4,551 attendances and have provided treatments, support and signposting in the heart of our community. Through our community engagement we take a proactive role in health and social forums, helping us engage with the patients early on in their diagnosis to ensure they can benefit from our wide ranging services as soon as possible.Our volunteer network has expanded to 1,124 volunteers and has facilitated the introduction of Companion Services, home help, welfare advice and an increased volunteer presence in our Inpatient Unit and Community Lodges. We are leading the way in working with volunteers to achieve the best experience for everyone.Providing EducationThe Education and Training Team has developed a range of educational programmes and study days aimed at enhancing end of life care within the community. Over 500 professionals attended these programmes in 2014/2015 including participants from care homes, housing associations, social enterprises, acute hospitals, Severn Deanery and Bristol BRI. The programmes are designed to help health and social care professionals and carers better understand the complexity of end of life care and to equip them to care for patients in their own homes.We have also developed educational programmes to break down barriers around the issues surrounding end of life within families and communities. This has resulted in community artwork projects and significant partnership with the education community to understand better the complexity, yet normality, of death and the role a community must play to support and nurture the bereaved. A highlight of this work was an art exhibition run in collaboration with Trowbridge College.Sharing KnowledgeDHHC has developed awareness both internally and externally around dementia and learning disability. We have become an active member of local forums such as the Wiltshire Dementia Delivery Board ( WDDB ), the Dementia Care Pathway Group ( DCPG ) within 10 Bath and North East Somerset, local Health and Wellbeing Boards and partnerships with other third sector organisations.We have developed our thinking on key health and social issues, including a pioneering review and debate on Assisted Dying, a position that is now being shared across the hospice community.Our work to better understand the needs of homeless people continues to grow and this year we delivered a range of study days for DHHC staff and local organisations who work with the homeless, such as Julian House.Developing ‘lighter touch’ supportDHHC continues to develop its ‘lighter touch’ support for patients, families and carers. Rather than being tailored for the individual, these services tend to provide more general information and support. For example, this can include our group sessions for patients on managing breathlessness or fatigue, which might take place in a communal setting at one of our sites.Our variety of services provide patients and carers with flexibility, choice and peer as well as professional support.An important element of our ‘lighter touch’ work is supporting patients earlier in their diagnosis and we have successfully piloted an ‘Early Referral Service’. It is anticipated that when this is rolled out across our region this will help patients and families to understand better the role of the Hospice and navigate the complex health and social care systems that exist. Helping to inform patients and families should also ease the pressure on GPs and their primary care colleagues for patient guidance and signposting following diagnosis. 11 Dying MattersArt Exhibition Case StudyIn September 2014, Dorothy House Hospice Care ( DHHC ) and Trowbridge College Art students embarked on a collaborative project to explore the theme of death and dying.Dealing with this subject can be difficult and often society tries not to think about it, let alone discuss it. DHHC set Trowbridge College Art students the challenge of exploring this theme, culminating in an art exhibition at Trowbridge Town Hall.Students were encouraged to visit the Hospice, talk openly with patients and ask any questions to help inform their work. The experience proved to be beneficial to all involved. One of our patients, Gary Cox, took part in the project.“Gary was able to release his feelings, I think this was cathartic for him and has helped to give others a better understanding of what he was going through.” (Sabrina Cox, on behalf of her husband, Gary Cox.)The resulting work has been inspiring and has shown a high level of maturity and understanding from every student. The pieces are all unique, using varied mediums and each expresses very different perspectives on the subject.Helen Chivers, Trowbridge College Art Teacher explains, “The students have gained a real insight into a subject that they may have previously only considered superficially. They have made personal connections with the patients and carers, enjoyed sharing their experiences and in response, developed original artwork that celebrates and raises awareness that ‘Dying Matters’.Although creating the work was challenging for the students, the experience has proved to be life-changing.“It is amazing how full of life the patients are. They have really inspired me to take full advantage of the opportunities in front of me ...you never know what is to come.” ( Isabelle Turner).“Doing this project has made me appreciate my life ... I do not really have anything to worry about... and I don’t always appreciate what I have. It has made me much more aware.” (Kimberly Urbanski)12 Opening the Dorothy House PurseOverspend of: £300KOur £300K overspend is in-line with our strategy to use our reserves appropriately to provide more care for patients, carers and families. DHHC currently holds reserves of 8.9 months, in accordance with the level set by the Board of Trustees.RetailThe early adoption of new Statements of Recommended Practice (SORP15) has resulted in a one-off reduction in profitability this year.13 How our money benefits patients, carers, children and familiesTotal £7.3MIncome Generation 2014/2015Dorothy House Hospice care ( DHHC ) is committed to maintaining an innovative and effective income generation stream, which is vital to the provision of our care services.Retail Highlights2014/2015 saw the successful launch of a DHHC shop in Weston, Bath with new branding. Our programme of re-branding and refurbishment of all DHHC shops is set to continue to ensure we maintain a strong visual presence in the high street.DHHC now has 28 shops across the area and thanks to the hard work of our volunteers and the donation of good quality items from the community; these shops make an important contribution to our income.Our retail arm is diverse and includes three furniture shops, a resorting and distribution centre and various online ventures. New ventures for 2014/2015 included eBay sales and an online book retail, which are important as we continue to develop new income streams.Fundraising HighlightsThe Fundraising Team manages a wide programme of activities ranging from events, community fundraising and giving programmes to legacies, corporate fundraising, appeals, trust and grant applications.The lively Bath Midnight Walk remains one of our biggest fundraisers and in 2014 we had almost a thousand ladies taking part to raise money and awareness for our Hospice at Home work.We are delighted to have held out third Bath Men’s Walk in March 2015,in partnership with the Bath Rugby Foundation, which saw 500 men complete an 8KM sponsored walk and enjoy a pie, pint and Six Nations rugby match whilst raising money for two local charities.Our Tulip Fund remains an important focus for the Fundraising Team and the Tulip Tea held annually at Easter for fund holders is a chance to join together and remember loved ones.“THANK YOU! MY WORK COLLEAGUE AND I THOROUGHLY ENJOYED OURSELVES. IT WAS SUCH AN AMAZING EVENING AND WE WERE REALLY IMPRESSED AT HOW WELL ORGANISED IT WAS. I’VE RAVED ABOUT IT AT WORK AND INSPIRED A FEW LADIES TO TAKE PART NEXT YEAR SO LOOK OUT FOR US!” Babs Bennington14 Dorothy House in Numbers2,724 nights have been spent on our inpatient Unit33,595 patient contacts managed by Nurse Specialist Teams19 patients per Nurse Specialist1,416 professionals attended education programmes hosted by DHHC1,124 in our volunteer network1,110 calls taken by 24hr Advice Line15 Independent Auditor’s ReportTo the members for the year ended 31 March 2015We have audited the financial statements of the Dorothy House Foundation Limited for the year ended 31 March 2015, which comprise the consolidated statement of financial activities, the balance sheets, the consolidated cash flow statement and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards ( United Kingdom Generally Accepted Accounting Practice).This report is made solely to the charitable company’s members, as a body, in accordance with Chapter 3 of Part 16 of the companies Act 2006. Our audit work has been undertaken so that we might state to the charitable company’s members those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the charitable company and the charitable company’s members as a body, for our audit work, for this report, or for the opinions we have formed.Respective Responsibilities of the Members of the Board of Trustees and the Auditor.As explained more fully in the Trustees Responsibilities Statement ( set out on page 15), the trustees ( who are also the directors of the company for the purposes of company law) are responsible for the preparation of the financial statement and for being satisfied that they give a true and fair view.We have been appointed auditor under the Companies Act 2006 and report in accordance with this Act. Our responsibility is to audit and express an opinion on the financial statements in accordance with the applicable law and International Standards on Auditing ( UK and Ireland).Those standards require us to comply with the Auditing Practices Boards Ethical Standards for Auditors.Scope of the Audit of the Financial Statements.An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the group’s and the parent charitable company’s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the trustees; and the overall presentation of the financial statements. In addition, we read all the financial and non- financial information in the Trustees Annual Report to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report. 16 Opinion on financial statementsIn our opinion, the financial statements:- Give a true and fair view of the state of the group’s and parent charitable company’s affairs as at 31 March 2015 and of the group’s incoming resources and application of resources, including its income and expenditure, for the year then ended;- Have been properly prepared in accordance with United Kingdom Generally Accepted Accounting Practice; and- Have been prepared in accordance with the Companies Act 2006.Opinion on other Matter Prescribed by the Companies Act 2006In our opinion the information given in the Strategic Report and Report of the Board of Trustees for the financial year for which the financial statements are prepared is consistent with the financial statements.Matters on which we are required to report by exception.“We have nothing to report in respect of the following matters where the Companies Act 2006 requires us to report to you if, in our opinion:- The parent charitable company has not kept adequate and sufficient accounting records, or returns adequate for our audit have not been received from branches not visited by us; or- The parent charitable company financial statements are not in agreement with the accounting records and returns; or- Certain disclosures of trustees remuneration specified by law are not made; or- We have not received all the information and explanations we require for our audit.Joseph ScaifeFCA DChA ( senior Statutory Auditor )17 Aims for Year AheadAt Dorothy House Hospice Care (DHHC), we want to encourage an innovative mind-set amongst out staff, volunteers and supporters,Set in the context of our Vision, Mission and Strategic Plan, here are some of our aims for the year ahead and ways in which we will deliver them:1. To ensure financial securityDelivering a financial surplus (FY16/17) through focused promotion, rigorous planning and transparent reporting, aiming for continuous improvement.We will...- Develop an innovative and pioneering retail proposition that introduces new ventures and reinforces our presence on the high street.- Continue and innovate proven fundraising and income streams whilst developing new initiatives including the DHHC lottery, run through Local Hospice Lottery, which has an anticipated income of around £500k by year five.2. To extend our reach to all in our 700sq mile areaDelivering reach and access to all those in need in our 700sq mile area, working with communities and volunteers to ensure that no patient, community or faith groups disenfranchised.We will...- Continue to develop our role as part of the community including providing ‘lighter touch’ support and services- Revisit the role of spirituality within the context of a charity founded on Christian principles operating within a diverse, multi-faith community.18 3. To become a leader in end of life careDelivering an innovative and integrated health and social care service that allows DHHC to become a leader and influencer for end of life care in the area, working in partnership with other stakeholders.We will....- Expand our Hospice at Home and care in the community in a manner that is responsive and aligned to future pressures and demand. DHHC will play a part in community based models of care that prevent admissions to hospital such that as Home First ( Wilts) and Discharge to Access (BaNES).- Grow DHHC’s Education & Training profile and services, developing innovative educational practice.4. To become an employer of choiceEnsuring access to the appropriate skill mix, which is well nurtured, developed, led and remunerated and to be recognised as an employer of choice.We will...- Empower DHHC staff through professional training, development and support- Ensure that DHHC staff have the equipment and facilities they need to work efficiently.19 Message from our Chief ExecutiveSince joining Dorothy House Hospice Care (DHHC) in September 2014, I have been struck by the total dedication of the entire workforce – supporters, volunteers and staff alike. We all want DHHC to be the best it can.It is not an easy financial climate for hospices. NHS England, through our local commissioners, must make huge efficiency savings and as ever, there are huge demands on the public to give to charity.What is remarkable therefore is that despite this, DHHC delivered a wider set of care services in 2014/2015, demonstrating value for money and real choice for patients and commissioners. This is no mean achievement and I applaud you all for playing your part in this.Partnerships have been key to many of our successes over the last year as we work with healthcare commissioners, local Health and Wellbeing Boards and alongside five bordering hospices. In the last year DHHC has reached out further into the community engaging with local government and businesses with shared values, seeking ways of working together. The future model of hospice care is being challenged and I am delighted to see that DHHC is continuing to look for innovative answers, working as part of the community.We have an exciting agenda and we are well on course to deliver against some challenging aspirations, providing even more services across a wider area, in a responsive and informed manner. We must ensure that DHHC is and continues to be there for the community when it needs us the most.Our guiding principle must be to develop ways in which Dorothy House Hospice Care can do things differently and better, in a sustainable manner, whilst remaining true to our vision and values.John Davies“ONE IN THREE PEOPLE WILL BE TOUCHED BY HOSPICE CARE AT SOME POINT IN THEIR LIVES.”Hospice UK Impact Report 2014 Thank YouOur work simply wouldn’t be possible without our supporters, donors, partners, volunteers and fundraisers.20

Dorothy House Hospice Care Annual Report and Accounts 2014/2015

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