INTRODUCTION

  We are delighted to give the following evidence for the above enquiry. We hope this is helpful and look forward to welcoming you to the hospice at a future date.

  Greenwich and Bexley Cottage Hospice (The Hospice) is the primary provider of specialist palliative care in the London Boroughs of Greenwich and Bexley. It provides Inpatient care for patients requiring symptom control, respite care and for those who which care in the terminal phase of their illness (usually last two weeks).

  In addition there is vibrant and well attended day hospice care facility providing care in an informal and supportive setting for any persons who are in the palliative care phase of their disease who wishes to come. For some this is the only social interaction they are able to access in their week and provides crucial informal assessment of their changing needs without patient needing to make difficult journeys to see their GP or visit the acute hospital.

  The hospice also sees its role in extending its service out into the community and to this end we have developed services which seek to link the patient within the home to appropriate services from the hospice eg a breathlessness service and hospice liaison nurse as well as specialist lymphodema service.

  The process of care for palliative care in Greenwich and Bexley is largely based on two community specialist palliative care teams who refer to hospice services. Bexley is charity funded and managed by `The Ellenor'. Greenwich is funded and managed by the NHS. Hence there are three organisations involved in the delivery of the service. A more preferred model is one well established nationally where the service is delivered by one organisation. This would provide a more coordinated and seamless process of care and communication for all involved and most importantly those who need to access the service; the patient.

1.  Choice/Provision

(i)  The Hospice is under funded in its bed base provision for the population size. The hospice has 19 beds for a catchment area of approximately 450,000 people. Given national indicators there should be between 25 and 30 inpatient hospice beds for a population of this size but to date due to appropriate use of in patient facilities we are meeting demand without a problem.

(ii) There is serious lack of responsive over night specialist and general nursing care and support in Greenwich borough. Bexley borough has 24 hour nursing service in place.

  Last year the hospice activity included:

400 episodes of care for in patients

150 day care patients with total day attendance being 2,000 days

500 patients used our day care clinics for lymphoedma and breathlessness service

700 people accessed the counselling service be it through attending group activity or one- to- one session's. A total of 3500 hours

(iii)  Choice can also be affected by referral patterns and referral routes. At times lack of understanding of the function and contribution hospice care can make to the individual and family members directly impacts on the whether or not they are referred. There is still the myth that "the hospice is the place you go to die". For some this is true but for 48% of our in-patients they return home.

Not all GP's and Hospital Consultants will refer their patients to specialist palliative care. Our view, based on feedback from patients and relatives, is that some patients and their relatives have to be very assertive to get a referral to the Hospice . . .

(iv)  The Hospice has a home liaison senior nurse to enable patient's timely access to hospice information and support from the full range of services such as Day care, Counselling, Lymphodeama, and Breathlessness services. This means that patients can benefit from all hospice services as their needs and wishes dictate.

2.  Equity

(i)  The client patient base at the hospice does not reflect the ethic minority's population in the two boroughs.

(ii)  Out reach is difficult multi language issues and expense of translating hospice information are inhibiting factors.

(iii)  Outreach to other specific belief groups has been challenging and almost impossible to effect but we are collaborating with the South Asian Cancer Support facilitator to accommodate in any way to promote ease of access to the range of services which the hospice does or could provide.

3.  Communication

(i)  Staffs are highly skilled to communicate with patients and their families. It is essential to promote an environment of trust and honesty so as to help the patient and their family to address, resolve and bring closure to issues which would block the end of life from being as peaceful and positive as possible.

(ii)  Communication at all levels and stages of the patient's journey is paramount and essential in the provision of a seamless journey for the patients.

(iii)  Counselling and Chaplain support for all is available 24 hours a day 7 days a week

4.  Quality of Service

(i)  The hospice is subject to review twice yearly by the Care Standards Commission.

(ii)  The Hospice Clinical Governance & Development Committee meets monthly and is a sub committee of the Board of Trustees and chaired by board member. It deals with all aspects of clinical audit, quality assurance of clinical/patient care and risk management.

(iii)  All internal monitoring systems feed back to clinical Governance committee.

(iv)  We are involved in developing an innovative cross borough user involvement mechanism to ascertain the quality of service & consult on future development proposals.

(v)  The hospice has received consistently high levels of extremely positive feedback from patients and relatives about the care provided. In particular patients and relatives comment on the striking differences between the care in a large acute trust and that given at the hospice.

5.  Meeting Age Groups Needs

(i)  The hospice deals with people from 16 years upwards. There are no other age related policies affecting access to the service.

(ii)  As noted above it has proved challenging to access differing ethnic minority groups within the borough. Attempts so far have not resulted in any sustainable programme.

(iii)  The hospice has both in- house & external resources to assist staff with cultural awareness.

(iv)  The hospice also provides counselling services for bereaved children.

6.  Governance of Charitable providers

(i)  The hospice is governed by the Board of Trustees which has two sub committees 1. Finance Committee 2. Clinical Governance Committee both chaired by a Board member.

(ii)  Charity commission

(iii)  National Care standards

(iv)  Local providers PCT and Care Trust

(v)  The hospices own Memorandum and Articles

7.  Standards and Links

(i)  The hospice uses similar policies and procedures as in the NHS

(ii)  The hospice acknowledges and employs nursing and clinical staff under the guidance of Whitley Council term and conditions and will be implementing recommendations form Agenda for Change as appropriate.

(iii)  The hospice is fully integrated into the local health care economy and contributes significantly to it through the provision of specialist palliative care

(iv)  The hospice is linked closely to Kings College London and Greenwich University for the provision of learning opportunities and teaching opportunities . . .

8.  Retention and training of staff

(i)  The hospice has an ambitious and far reaching staff development process. All clinical staff undergo annual performance training needs analysis and are working towards a recognised academic or vocational qualifications

(ii)  Staff recruitment is good. Posts are filled quickly and their is often a waiting list for jobs at the hospice

(iii)  Staff retention is good. Approx 20% of staff has been with the hospice since it opened 1994 and we have good succession planning in place.

(iv)  The hospice provision of extensive training both in role related areas and personal development to all groups of staff is a priority within is strategic objectives. Staff, as a result have a high level of motivation and commitment to the service and minimises staff burnout.

9.  Funding

(i)  The hospice receives about 36% NHS funding these needs to increase as part of the Cross Cutting Review Work on the payment of Core clinical costs.

(ii)  The hospice does have good support from the Bexley Care Trust, unfortunately support form Greenwich PCT is not as well developed or evident

(iii)  The hospice relies upon its charitable endeavours—Fundraising events such as, Fun Days and Shop income for its continued survival. The future is never certain. Fundraising is a highly specialised area requiring its own expertise.

(iv)  The hospice did not receive any money from the £50 Million cancer funding from Greenwich PCT they used this money to offset its own cash problems instead of giving the money to the specialist palliative care providers in Greenwich. This clearly further accelerates the problems of deprivation and access to specialist palliative care services in Greenwich. This also raises the issue of trust and respect when considering further joint working with Greenwich PCT.

10. Government Policy

(i)  National Service Frameworks have proved useful in involving views and directions on palliative care in non cancer areas such as coronary thrombosis. It has been help full to raise the issue that palliative care is needed for all groups in health care who may be approaching death or on a life limiting trajectory.

(ii)  The Cancer Plan again has been helpful in raising the hospice profile and getting a wider picture of cancer care provision underpinning the significant role each Hospice does play in this. But again funding from Greenwich PCT has not been given to the hospice as it was intended by the Government. To implement the Cancer Plan.

(iii)  NICE recommendations these have been published which have proved a useful to help plan, commission and develop local palliative care with Bexley. The one area of concern we have relates to the paucity of information and proper consideration given to the role of day care provision. A facility which nationally continue to grow in demand with an increase in the creative provision of services. There is a need to recognise the role of evaluative research in this area and invest time and funds to articulate what the users finds so essential to their quality of life. This is a piece of work we as an organisation would welcome to be involved with.

February 2004