2011
Annual Report
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Mission Statement
To provide a specialist palliative care service for patients with specific life-limiting illness living within the catchment area of North East Wales and the border areas and to support their families in a caring environment. This will be undertaken by a specialist trained multi-disciplinary team who will provide symptom control, assessment, terminal care, and on-going emotional support for relatives and carers, bereavement support, education and information.
Directors and Trustees Committee Members Mr M Edwards (President) Mrs E Griffiths (Chair) Dr N Braid (Vice Chair) Mrs P Valentine (Secretary) Mrs A Wood Mr C Burgoyne Mr M H Phillips Mr A Morse Mrs J Lowe Mr N Davies Mrs E Walker Dr J Duguid. Nightingale House Hospice Chester Road Wrexham LL11 2SJ Tel: 01978 316 800 www.nightingalehouse.co.uk Wrexham Hospice and Cancer Support Centre Foundation
Registered Charity Number 1035600 Company Number 02906838 (Registered in England & Wales).
Acknowledgements and thanks to: Gareth Hughes, Gavin Priest and Kris Williams.
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�
I trust them and they listen to me
Patient, August 2011
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Contents Chair of the Board of Trustees
2
Chief Executive
4
Director of Nursing
6
Associate Medical Director
8
Director of Income Generation
10
Volunteer Liaison Manager
12
Finance Manager
14–15
Selection of 2011 Photographs
16–17
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Chair of the Board of Trustees Eluned Griffiths
My first year as Chairman of the Board of Trustees is coming to an end and it has been a privilege to serve the Hospice in this capacity. It is has been a year which has seen inflation push our running costs to almost £2.5 million whilst the statutory section’s contribution of approximately 20% remained the same, a decrease in real terms. It has been a challenge to raise this level of funding not only because of the uncertain economic climate, but also due to local competition from the National Eisteddfod fundraising campaign. Throughout 2011 the Income Generation Department continually evaluated and improved fundraising methods and pursued innovative ways of raising monies. This contributed to our success in achieving the necessary level of income but, equally important, was the magnificent support of our community. On behalf of myself and my fellow trustees, I pay tribute to the hard work of the individuals, community groups and corporations without whose contribution our target could not have been achieved. This support enabled us to continue to maintain all the services provided for our patients and their families. I thank all staff for their professionalism in ensuring departments kept within budget and continued to deliver a high standard of care, as well as providing ‘that something extra’, which adds so much more to the wellbeing of patients and their families.
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I must also thank our 500 volunteers in recognition of the time they give freely throughout all spheres of hospice activity. Without their input we would not have been able to maintain the level of our services. We are a people and patient centred organisation and the money raised is essential to finance our highly trained and skilled clinical team and the clinical services they deliver. Despite a difficult year, it was an achievement to reach our funding targets and to provide over 5,298 patient episodes of treatment, maintaining a high quality of service and, importantly, that they continued, and will continue, to be free to our patients and their families. However, we cannot be complacent. There are more economic challenges to be confronted in the years ahead and we must continue to strive to ensure that our funding needs are met. Finally, I thank my fellow trustees and staff for their invaluable support and their professionalism during this year which has ensured that Nightingale House has achieved its objectives and has continued to play an important role in the provision of specialist Palliative Care to our community and to BCUHB.
| Annual Report 2011 26/03/2012 12:57:40
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Gave so much with genuine care and kindness
Patient May 2011
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26/03/2012 12:57:43
Chief Executive John Savage
As you read through this report you will see that in 2011 Nightingale House continued to deliver a first class service to all the patients and families we cared for. This, in itself, is not remarkable as over the years we have developed a reputation for our quality and excellence of service. What is remarkable is that we have not only maintained the same level of service at a time of great financial uncertainty, at both a local and national level, but have also continued to deliver innovation in those services. This is a great testimony to all staff who have worked so hard and whose professionalism always comes first. I am particularly pleased with the financial performance throughout the year, which resulted in us achieving our objectives, especially as we have seen so many charities suffer through this period of financial uncertainty. As always, the foundation for our success is the community that supports us, without whom we could not maintain the service levels we do. Whether through fundraising, attending events, donating goods, services or money, membership of our lottery or volunteering we would not be able to maintain and deliver the range of services the community needs, a big thank you to you one and all. To achieve these outcomes year on year we have to undertake meticulous planning exercises to ensure that we have sufficient resources to meet the service needs not just now but into the future. Part
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of this planning in 2011 involved looking at energy consumption and ways that we could stabilise, if not reduce, our energy costs over the coming years. By the time you read this report a decision made by the Board of Trustees in the last quarter of 2011 to invest in photovoltaic solar panels will have come to fruition, with the installation of 208 solar panels generating just under 50,000kw per year. This will give a first year income to the Hospice of £20,000 and as much as £750,000 over the 25 year life of the government programme — money that can be used to continue to support clinical services. Even though over the next few years we will be faced with a period of economic uncertainty, we are planning to maintain current service levels. We do have aspirations to expand our services but without tangible increases in sustainable funding it will not be possible to implement these plans. Due to the financial pressures on the NHS, and at a time when demand for our services has never been higher, we cannot even guarantee that the level of funding received from our Local Health Board will be maintained at the current level of 20%. It is, therefore, even more important that our community continues to support us in every way they can to ensure that we can continue with our good work.
| Annual Report 2011 26/03/2012 12:57:48
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The care during my stay has been exceptional in every way with lots of TLC (tender loving care) compassion and humour
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Patient, June 2011
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Director of Nursing The Annual Report gives us the opportunity each year to review each of our services and consider the impact we have made on the lives of patients and families referred to our care. In 2011, through the development of the Monday Programme of drop-in sessions at the Hospice, we are now able to make that impact count for patients much earlier following a diagnosis of a life limiting illness. Patients who may not need formal input through outpatients or day care benefit from access to useful information, lifestyle tips and the opportunity to talk about the impact their illness is having on their life and relationships. The programme is supported not only by our day unit nursing team, but also by our rehabilitation team, physiotherapists and occupational therapists, who provide sessions on ‘Breathlessness’, ‘Fatigue Management’, ‘A little Exercise’ and ‘Relaxation’ with the emphasis being on self-help and empowering patients to manage their own health and wellbeing. A further emphasis on self-help has been offered through the ‘Mindfulness’ skills training programme, co-facilitated by our chaplain co-ordinator and designed to encourage individuals to focus on the present time, rather than using their energy thinking about the past or future. Feedback has been very positive from participants using these initiatives, which were introduced using existing resources in a new and innovative manner. As the treatments for cancer have improved, so has life expectancy following diagnosis. As such, we not only see hospice patients living longer, but potentially developing other conditions or comorbidities as time passes. This presents new demands on patients and their families and our social work team continues to work with patients offering support and addressing the practical issues of their changing circumstances. These co-morbidities mean there is a need to work more closely with colleagues in other specialities, drawing on each other’s knowledge and expertise
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| Annual Report 2011
Tracy Livingstone
within our education programme to ensure staff members are able to meet the changing needs of our patients and families. Our work with the infection control team over the last twelve months clearly demonstrates the positive impact of joint working. Infection control is very much on the health agenda and as such it is imperative that the Hospice and staff are aware of current issues and respond appropriately to operate within current legislation and guidelines. The work over the last year has been approached in a number of different ways; the flooring on the inpatient unit has been changed from carpet to vinyl, improving cleanliness and efficiency when dealing with spillages etc. In addition, all staff working in clinical areas undertake mandatory infection control education and our link nurse liaises with the specialist team to agree content and priorities each year. We have also continued to provide training placements for students throughout the year through our existing links with Glyndŵr University, for nursing and occupational therapy students, and developing new links for physiotherapy student placements with the Universities of Birmingham and Manchester. Looking back on the work of each of the clinical departments during 2011 it has been a busy year. It has been a challenging year in terms of the continued need to use what is a limited resource responsibly and to continue to achieve the greatest impact on the needs of patients and their families. Despite all the challenges we face, patients and their families remain at the centre of the care we provide. Thanks to all our staff, volunteers and supporters whose commitment and determination make the services we provide the best that they can be.
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I’ve had the best care I’ve ever received in any hospital. This has helped my pain so much I’m going home for the weekend and coming back in on Monday, looking forward to it
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Patient, July 2011
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Associate Medical Director Dr Nigel Martin Each year seems to supply new and increased challenges to the provision of Palliative Medical Services in Nightingale House Hospice. Before I discuss these challenges, I must report on one significant change, in that Professor Matthew Makin has resigned from his post as the Honorary Medical Director to enable him to concentrate his energies in his role as a Chief of Staff and Consultant in Palliative Medicine for Betsi Cadwaladr University Health Board (BCUHB). He will continue as ‘Visiting Palliative Medicine Consultant’ to the Hospice and will remain on the medical on-call rota. He has held the post of Honorary Medical Director for eleven years and has been the driving force in developing Palliative services, not only in Nightingale House, but also in North East Wales. He has seen the Hospice develop from childhood to maturity as a beacon of innovative Palliative Care, and he will be greatly missed in his managerial role. We are glad he still has a close connection with Nightingale House, and wish to thank him for all his dedicated work for us both in the past and in the future.
they tend to develop more complex symptoms and are often considerably more ill when they attend the Hospice. We have also developed particular expertise in supporting people with degenerative neurological diseases such as Motor Neurone Disease. Traditionally, people with these diseases have received very fragmented support, primarily due to rarity of their conditions. However, to improve the quality of their lives a co-ordinated and holistic approach is required, with the involvement of many different specialties and the need to develop new skills — such as the problems of looking after patients who are using non-invasive ventilation during and at the end of life. Additionally, we are receiving referrals concerning increasing numbers of patients with non-malignant disease. These conditions not only present new challenges in symptom control, but also in ensuring that we are up to date in their treatment.
The medical team at Nightingale House has essentially remained the same. Strong links have been maintained with the BCUHB in that we continue to support clinical placements of Palliative Medicine Registrars, Foundation Year One House Officers and also visits by Cardiff University medical students. They have all benefitted enormously from their time with us. Over the last year, we had the additional attachment of a Clinical Lecturer in Palliative Medicine from Glyndŵr University, who not only provided valuable medical help, but also superb education sessions to our staff.
The increasing pressure on NHS beds places additional demands on Nightingale House as it has resulted in patients being transferred from acute care to the Hospice more rapidly. These patients are often at an earlier stage of their recovery from treatment and may present us with a higher level of dependency on care. Financial constraints on statutory services can also increase the difficulty in discharging patients back to their own homes from Nightingale House, where delays occur due to the complexity of arranging care in the community.
A significant and ongoing challenge is in the changing face of Palliative Medicine. Over the years, it has become apparent there has been an increase in the complexity of conditions that we now treat. This not only reflects that people live longer, due to improved cancer treatments, but that
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However, to conclude, it is not all ‘doom and gloom’. Nightingale House has shown itself to be very adaptable over the years and continues to meet demands by providing the type of care and help which, I feel, is in the forefront of Palliative Care. I am certain that this will continue in the future.
| Annual Report 2011 26/03/2012 12:58:16
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The staff are not just efficient but uplifting in their cheerfulness
Patient, October 2011
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Director of Income Generation Caroline Siddall Nightingale House Hospice is often referred to as being at the heart of the community and, perhaps more than ever, 2011 has highlighted this. During what has been a very difficult financial period for everyone, it has been with your continued support that we have yet again achieved our challenging financial goals ensuring our clinical teams are able to continue to provide the highest standards of patient care that has become synonymous with Nightingale House. During 2011, the Hospice organised a number of fundraising events, including the Annual Ball which was kindly sponsored by MWL Systems. In total, events have raised over £268,000. The support received from the community has resulted in donations exceeding £338,000, much of this coming from supporters planning and organising their own events. Included in this amount is £95,000 that has been raised by 190 of our supporters taking part in activities such as marathons, parachute jumps and mountain climbing all for sponsorship. In addition, eight of our regional Support Groups, many of whom have supported us since the founding of the Hospice, have raised over £24,000 through their various and many activities. The local community certainly took our message of ‘every penny counts’ to heart during the year with our bag packs, street collections, yellow tins and small ‘house shaped’ collection cubes raising over £58,000 in loose change — no matter how small a donation may seem it all helps towards our continuing patient care. Our corporate supporters raised over £100,000; £20,000 of which was donated by NISA — Making a Difference Locally, who sponsored a member of the nursing team for a year.
in Need to assist with funding Release, our child bereavement programme. We were also very proud to have been chosen by Wales Rugby League to be their charity for the duration of the Rugby League Four Nations Competition. This resulted in the Hospice logo appearing on the front of the team shirts, where it could be seen on TV sports coverage such as Sky Sports and BBC Sport, helping to raise the public profile of Nightingale House. Our retail business continued to grow with the opening of a new charity shop on Rhosnesni Lane to expand our furniture showroom and led to an increase in income of £29,000 (28%) from this shop. We have also generated an income of over £51,000 from our recycling business which is an increase of £15,000 (43%). Overall, our retail business has produced an income of £494,000 which is an increase of £78,000 (19%) from 2010. With the support of an external canvassing company, lottery membership has increased by 2538 new members, giving a very healthy total membership of 15,654. This has resulted in an increase in income of £100,000 (17%) from 2010. As we face the start of each year, we are always conscious of how much of a challenge we face with our fundraising. However, each year we are overwhelmed by the support we receive from our community. On behalf of our patients, their families and our staff I would like to thank you for your continuing support, without which there would be no Hospice.
In November, we were notified that we had been fortunate enough to receive a continuing grant of £30,000 per year for three years from BBC Children
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| Annual Report 2011 26/03/2012 12:58:31
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During 2011, we were supported by the following companies as their ‘Charity of the Year’ and we thank them for their continued support. Allington Hughes Buckley Insurance Cash for Gold Wales Rugby League DW Sports EADS
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Hadlow Edwards Hillyer McKeown House Name Plate Jolly Good Van Hire Marks and Spencer Money MWL Systems
Nice Pak NISA Parkway Telecom Sainsbury Stoneacre Travail WholeBake 26/03/2012 12:58:36
Volunteer Liaison Manager We are privileged at Nightingale House Hospice to have such a vibrant ‘Volunteer Army’ who continue to provide increasing amounts of time to further our aims and objectives, both in the Hospice and the wider community. We continue to attract an increasingly diverse group of volunteers who enable us to spread the positive hospice message more widely. The volunteer cohort has been much enhanced this year, with increasing numbers of 16–18 year olds studying for the Welsh Baccalaureate Award. The volunteering requirement within the Award matches our need for volunteers, particularly at fundraising events. Volunteers are able to build up their portfolio with a range of activities including bag-packing, fayres and one off events. Our system of quantification of individual volunteer hours not only enables volunteers to build their Portfolio of Volunteering, it also offers further opportunities for volunteering in the Hospice for those young people interested in pursuing a related career path. At this year’s Help the Hospice Conference in Bournemouth, we were able to promote our Young People’s Programme, demonstrating its effectiveness and providing a great opportunity to share best practice within the national hospice community. Volunteers recruited to help at fundraising events are encouraged to bring either a friend or member of
Val Connelly
the family to help with the event and have fun. These extra hours have made a significant difference to the number of volunteer hours recorded throughout the year. We are always keen to welcome new volunteers! New methods of social networking are also proving to be a successful way of recruiting and keeping in touch with volunteers. Currently, Facebook and Twitter are used with a growing following. Contact with volunteers is also conducted through phone, email or by SMS. Volunteers are sent details of fundraising events in booklet form with the quarterly newsletter. Availability is then logged and confirmed two weeks before each event using the volunteer’s preferred method of contact. The recent economic downturn has meant that the requirement for volunteers has increased with an increasing number of events. The total number of hours contributed throughout the year is a great testament to the generosity of all our volunteers who have risen to these fresh challenges magnificently. Thank you. Without you it would not be possible.
Volunteer Statistics for 2011 63,513 hours were contributed by over 500 Volunteers. 706 hours were contributed by Friends and Family Members in two hour slots. There was an increase of 18% on last year’s total hours. There are 76 Volunteers under 25 years of age.
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| Annual Report 2011 26/03/2012 12:58:37
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Finance Manager Income 2011
Restricted Grants 2%
Misc 4% Local Health Board 14%
Lottery 22%
Neil Williams
Investment Income 1%
Facts and Figues
Group Income £3.3 million
Shop Sales 15%
£6600 will fund the Hospice for one day.
Donations 22% Welsh Government 5%
14% — amount of income received from Local Health Board. £278,000 — amount raised by Lottery for charity.
Events 9%
66 days of patient care funded by Lottery.
Legacies 6%
22% of total income comes from Hospice Lottery.
How funds are utilised on the provision of patient care Day Care 9%
£110,000 — the amount raised by the Hospice charity shops.
Alternative Therapies 3% In Patients 60%
Education 1% Social Workers 4%
Nearly half a million pounds of sales through the charity shops. 19% increase in sales through charity shops. £716,000 — amount of donations received.
Medical 13%
171 days of patient care funded by general donations. £299,000 — amount raised from Hospice fundraising events.
Occupational Therapy 3%
71 days of patient care funded by fundraising events.
Physiotherapy 7%
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| Annual Report 2011 26/03/2012 12:58:40
Financial Statements Consolidated Statement of Financial Activities (incorporating an CONSOLIDATED STATEMENT OFaccount). FINANCIAL ACTIVITIES (INCORPORATING AN INCOME AND income and expenditure Year ended 31 December 2011. EXPENDITURE ACCOUNT). Year ended 31 December 2011 INCOMING RESOURCES Incoming resources from generating funds Voluntary income – Grants and donations Activities for generating funds Investment income Incoming resources from charitable activities Other incoming resources – profit on disposal of fixed assets TOTAL INCOMING RESOURCES Resources expended Cost of generating funds Fundraising costs of Hospice Commercial trading operations Investment management costs Charitable activities Governance costs Other TOTAL RESOURCES EXPENDED Net incoming / (outgoing) resources before transfers and other recognised gains and losses Transfer between funds Unrealised (losses)/gains on investment assets Realised gains on investment assets Net movement in funds Total funds at 1 January 2011 TOTAL FUNDS AS AT 31 DECEMBER 2011
Unrestricted Funds £
Restricted Funds £
1,329,652 1,541,738 36,023 197,015
Year ended 31 Dec 2011 £
Year ended 31 Dec 2010 £
28,550 62,154
1,358,202 1,541,738 36,023 259,169
1,312,213 1,391,163 28,777 262,399
104,840 3,209,268
90,704
104,840 3,299,972
82,346 3,076,898
388,217 865,575 6,361 1,859,309 7,676 3,127,138
3,632 2,175 168,937 174,744
391,849 867,750 6,361 2,028,246 7,676 3,301,882
384,858 741,890 4,517 1,997,444 6,883 3,135,592
82,130 (108,671) 41,873 15,332 2,989,872 3,005,204
(84,040)
(1,910)
(84,040) 2,195,269 2,111,229
(108,671) 41,873 (68,708) 5,185,141 5,116,433
(58,694) 78,698 14,015 34,019 5,151,122 5,185,141
Consolidated and Charity Balance Sheets, as at 31 December 2011. CONSOLIDATED AND CHARITY BALANCE SHEETS. As at 31 December 2011 FIXED ASSETS Tangible assets Investments DEBTORS DUE AFTER ONE YEAR Debtors CURRENT ASSETS Investments Stock Debtors Cash at bank and in hand
Group 2011 £ 3,121,737 1,048,699 4,170,436
Group 2010 £ 3,320,674 1,086,146 4,406,820
Charity 2011 £ 2,864,879 1,048,701 3,913,580
Charity 2010 £ 3,063,858 1,086,148 4,150,006
-
-
-
28,118
Creditors : amounts falling due within one year
152,426 23,831 98,376 961,209 1,235,842 (277,345)
152,395 17,125 106,829 792,982 1,069,331 (278,245)
152,426 11,741 156,482 794,828 1,115,477 (133,725)
NET CURRENT ASSETS Total assets less current liabilities
958,497 5,128,933
791,086 5,197,906
981,752 4,895,332
Provisions for liabilities and charges NET ASSETS FUNDS Unrestricted funds Restricted funds TOTAL FUNDS
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(12,500)
(12,765)
(12,500)
152,395 9,525 125,747 645,292 932,959 (148,953) 784,006 4,962,130 (12,765)
5,116,433
5,185,141
4,882,832
4,949,365
3,005,204 2,111,229 5,116,433
2,989,872 2,195,269 5,185,141
2,849,097 2,033,735 4,882,832
2,833,765 2,115,600 4,949,365
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2011
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