Building a Community, Annual Review 20/21

Building a Community Annual Review 2020/21

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St Columba’s Hospice Care Annual Review 2020 – 2021

Chairman’s Statement — During the hardest times our community makes us stronger.

The year 2020/21 has been a year like no other.

A year dominated by our collective response to Covid-19. The onset of the first national lockdown in March last year saw the whole UK face a unique and unprecedented situation. It’s been a privilege to witness how St Columba’s Hospice Care has evolved and adapted its ways of working to accommodate the impact of a global pandemic, and I would like to start by thanking everyone at St Columba’s for their incredible efforts.

With our charity shops closed and our fundraising events cancelled, we experienced a sudden and dramatic loss of income. Our committed army of volunteers were temporarily stood down as the Hospice focused on its core services, staff moved to home working where appropriate and all necessary precautions were taken to ensure the safety of our patients. Our senior management team met daily to assess new guidance, consider risks, review our provision and make timely decisions on next steps. Despite challenges, the team ensured that care remained a priority and in addition to providing the vital services and support that is essential to our patients and families, we are proud to have been able to maintain family visits on our wards throughout the height of the crisis.

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The Hospice’s new three-year strategic plan, “Adapting to a Changing World”, is about responding to the diverse needs of our community and was developed following a programme of board, workforce and stakeholder engagement in 2019 and 2020. Its launch coincided with the onset of the crisis and the significant involvement of our teams in planning the new strategy meant they were prepared and ready for change, enabling the Hospice to move at a much faster pace when the pandemic arrived.

We’re already able to report an increase in the number of ways people are accessing our services out-with the Hospice. For example, our newly structured Community Hospice Team saw a 25% increase in referrals throughout the year and many more people were

supported at the end of life in their own homes – a clear indication that we continue to move in the right direction.

In common with most charities, we suffered a significant loss of income during the pandemic and were very grateful to receive government grants and other donations to help us through.

We are also fortunate to hold reserves which have recovered well following the impact of Covid-19, allowing us not only to weather the storm but also to plan our future services in accordance with our strategic plan.

The values that underpin our professional care have never been more important than at the present time. We will never be complacent and will continue to listen to the people we care for, and to staff who are responsible

We’ve embraced exciting opportunities to better our service provision as we prepare for what many are referring to as the ‘new normal’

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St Columba’s Hospice Care Annual Review 2020 – 2021

Our Community Hospice Team saw a 25% increase in referrals throughout the year

for that care, so we can continually improve. We remain confident that Trust, Care and Compassion, Partnership and Respect, reflect the values we aspire to each and every day.

Our primary goal will always be to continue reaching those who need us most. We’ve taken remarkable learnings from the lockdown period, during which time we integrated digital technology in new ways, consolidating its role as a key part in maintaining continuous care for our patients.

We’ve embraced exciting opportunities to better our service provision even further and as we prepare for what many are

referring to as the ‘new normal’, we do so with determination and ambition. We’ll continue to harness our innovation and learning, our knowledge and expertise, to deliver positive, long-term impact and ultimately achieve better outcomes for the patients and families we support.

As ever, we are humbled and truly grateful for the ongoing support from our local community and beyond. Sincere thanks goes to everyone who supports the Hospice in any way; it’s because of you that we’re able to look forward and continue to provide vital care to patients and families who need it most.

David Dunsire, Chair of the Board of Governors

Our three year strategic plan,“Adapting to a Changing World”, is about responding to the diverse needs of our community

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St Columba’s Hospice Care Annual Review 2020 – 2021

Partnership — Tirelessly working with those who share our values

– Used virtual consultation technology (ECHO) to support Care Home staff in learning best practice. Further ECHO networks have been established with NHS Lothian volunteers, the homelessness support teams and the Art in Palliative Care community to further enhance their practice.

Our Compassionate Communities team is helping to reshape attitudes towards death and dying

As healthcare and it’s delivery continues to get more complex, we’re placing more focus than ever on partnerships and collaboration to better understand and respond to the needs of our community, to continually upgrade the quality of life in the community and to improve access to quality of care to all those we serve.

In 2020/21 we:

Building stronger partnerships in our community also helps us to extend our brand and strengthen our position as a leader in palliative and end-of-life care in Scotland.

–E stablished a Compassionate Communities team who cultivate and develop relationships with community groups across Lothian, helping to reshape attitudes and behaviours towards deteriorating health, dying and bereavement.

–D eveloped a Compassionate Neighbours project through recruitment and training of 28 volunteers to work with and support people at home. Over the past 6 months this support has been virtual but will move to face to face as restrictions ease.

– S hared new knowledge and created innovative ways of working to influence the wider provision of palliative and hospice care.

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– Contributed to national work developing a national children’s and adult’s Bereavement Charter.

– Worked in partnership with NHS Lothian and Marie Curie Hospice Edinburgh to maximise hospice support throughout the pandemic by reshaping and enhancing community based services.

– Worked collaboratively with Scottish Hospices and Public Health Scotland to generate Hospice specific pandemic guidance.

– Recruited a new Community Choir Facilitator who established a Virtual Hospice Choir.

– Worked with CHAS and young adults to explore ways to improve the experience of young adults transitioning to adult palliative care services.

– Developed a model of care for homeless people across Lothian in partnership with Marie Curie Hospice Edinburgh and supporting GP practices.

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St Columba’s Hospice Care Annual Review 2020 – 2021

We quickly adapted our arts service so that patients and families could take part from home (Artwork by Pamela Curran)

– Further established joint fundraising initiatives in partnership with the other Scottish hospices in order to maximise national income generation opportunities.

A significant gift of £1 million was shared across the Scottish hospices through this venture.

Digital advancements: – Developed our website to create engaging information on our Arts service.

– Utilised the hospice website and social media pages to keep the public informed on the changing restrictions within the Hospice.

We’ve maintained and extended our networks through virtual consultations

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–C reated a new weekly electronic bulletin for volunteers to keep them connected with the Hospice during lockdown.

–U tilised technology to support income generation throughout the pandemic. This included promoting contactless payments in shops, creating virtual events for supporters and virtual ‘in memory’ opportunities for families.

–P rovided comprehensive training for the Counselling and Bereavement service in order to provide virtual counselling support over the past 6 months.

–E mbraced ‘Zoom’ technology to maintain contact and relationships with our volunteer workforce throughout the lockdown period.

– Hosted an online Time of Remembrance via social media.

– Developed an online creative writing project funded by the Scottish Book Trust, with videos produced which are serving as resources on our website.

– Further developed the Hospice website to ensure patients, families and the public have access to accurate and clear guidance on loss, grief and bereavement. Particular tools were provided for children and young people.

– Developed and implemented a modern and robust IT system across all services which continues to support flexible and remote working.

Our team has been contributing to a national children’s and adult’s Bereavement Charter

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St Columba’s Hospice Care Annual Review 2020 – 2021

Care & Compassion — Delivering high-quality care with empathy, respect and dignity

Our Team Care is at the core of our organisation and defines our work.

In 2020/21 we had 236 employees and 650 volunteers, both clinical and non-clinical, committed to delivering high-quality care with empathy, respect and dignity.

At St Columba’s Hospice Care, we pride ourselves on delivering care that’s personal. That means we’re passionate about ensuring that the care and support we provide is tailored to an individual’s specific needs. A key component to achieving this is our multidisciplinary approach to patient care. Our team is dedicated to working together towards the common goal of enhancing each patient’s health and wellbeing through the highest possible level of care. That commitment to our patients and families and to each other, is what makes the Hospice a truly special place to work.

We continue to place great emphasis on the importance of staff and volunteer engagement, and this has been central to overcoming the challenges we’ve faced throughout the year.

In 2020/21 we: – Established a Staff Voices group, led by staff, to enhance communication and engagement across the staff workforce.

– Introduced a newly structured and streamlined induction programme which encourages staff to engage with their learning and development, ensuring they feel both supported and informed throughout the initial weeks of starting a new role.

– Embedded the Hospice values into people initiatives bringing our values to life e.g. within our recruitment strategy and the introduction of new staff appraisal processes.

– Developed a culture of reflective practice, providing opportunities for learning from and within practice, supporting emotional health and wellbeing. This includes a new arts focussed group open to all staff and a new group for community staff nurses and support workers.

– Developed a senior clinical on call system to facilitate workplace leadership out of normal working hours.

– Developed an online learning hub utilising different online platforms for learning and development.

This has increased uptake of learning through flexibility of access to the materials.

– Launched a monthly session called ‘Hospice Connections’ giving staff and volunteers a platform to speak about their roles, current projects and topics of interest.

We’re passionate about ensuring that the care and support we provide is tailored to an individual’s specific needs

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St Columba’s Hospice Care Annual Review 2020 – 2021

We’ve reallocated our resources to meet the demand for, and enhance, our community care offering

– Created a dedicated section on our website for staff and volunteers which allows quick and easy access to the latest information and training available.

– Embraced online meeting platforms such as Teams to maintain communication.

Our Care In March 2020 we radically transformed the way we delivered care both clinically and operationally, in response to the emerging health crisis and financial challenges that it presented.

Our inpatient unit adapted rapidly to ensure services remained firmly in place, visiting restrictions were introduced, PPE became essential for all staff working in clinical areas and necessary changes were implemented to create a safe environment for patients, families and staff. To meet the demand

for hospice care, we worked hard to deliver more services virtually than ever before. We suspended face-to-face outpatient services, instead offering support remotely for patients living in the community, but continued making essential home visits.

In 2020/21 we: – I ntroduced the electronic patient record system TRAK which ensures real time shared records across Lothian, improving communication across patient services.

–S upported patients and families over the phone and with virtual consultations via a secure video call using the NHS system ‘Attend Anywhere/Near Me’.

– I mplemented a single point of access to hospice care for patients and families. All referrals now come to a central access team of senior clinicians who

triage the referral and s ignpost the patients to the most relevant service.

– Created a multi-professional community hospice team comprising of nurse specialists, staff nurses, doctors, clinical assistants, a physio and an occupational therapist. This team now provides a variety of skills to support the diverse needs of patients and families.

– Launched a dedicated family support section on the website providing useful information, advice and resources for family members, friends and carers.

Inpatient Care Our inpatient unit has been restructured in line with our new strategy and is now made up of 22 single bedrooms across two wards. In 2020/21, we had 316 admissions to the inpatient unit

We worked hard to create a safe environment for patients, families and staff

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St Columba’s Hospice Care Annual Review 2020 – 2021

with an average occupancy of 86%. The reduction in bed numbers allowed us to release staffing resources to meet the demand for, and enhance, our community care offering.

–F urther developed our domestic services to guarantee adherence to National Patient Safety systems ensuring high level infection control standards across the organisation.

Chaplaincy contact (for individuals of any religion, or none) was made with almost all patients and families using our inpatient services.

Community Care

In 2020/21 we: – Established a hospitality team to provide a more person centred approach to inpatient catering.

– Built children’s play parks within the Hospice grounds to support family play.

– Extended the Hospice cycle and tool shed to accommodate an increase in the number of cyclists visiting the Hospice buildings.

Hospice care is not about a hospice building. Hospice care is about providing people with the very best care in the way that best suits their unique circumstances. Often that means us caring for people in their own communities and at home.

When developing our ‘Adapting to a Changing World’ strategy, we recognised an unmet need for a more community-based end of life care model. In response, we set about developing and shaping our service to meet the needs of our community. Our reconfigured

‘Community Hospice’ consists of two multi professional teams and a new Hospice at Home service providing hands on care for people in their own homes.

In 2020/21 we: – Admitted 772 new patients to our community hospice service, a 25% increase compared to the previous four year average.

– Provided 12,450 interactions with our patients. This is higher than previous years as a result of the Hospice adapting services to meet Covid-19 safety restrictions.

– Supported 181 people to die in their own home, a 43% increase on the previous four year average.

– Secured premises in Haddington House to deliver outpatient and bereavement support closer to

We partnered with Royal Scottish National Orchestra to offer free online concerts to our patients, families, carers, staff and volunteers

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St Columba’s Hospice Care Annual Review 2020 – 2021

In 2020/21 we saw a 66% increase in counselling services when compared to the previous four year average

home in East Lothian. Due to Covid restrictions no service delivery has taken place as yet but the space supported staff as office space minimising non-essential travel.

– Secured additional funds to purchase two electric bikes to support the Community Hospice team on visits to patients and families.

Supportive Care Our supportive care services are about making it easier to manage symptoms and improve general wellbeing. They’re all available to inpatients, outpatients and those in the community.

The need for our counselling and family support services has never been greater. The impact of the pandemic is anticipated to lead to a significant increase in the need for bereavement support due to restrictions on visiting, funeral attendance and general access to healthcare and supportive care services.

In 2020/21 we: –H osted a free online Arts Symposium, the first of its kind in Scotland, bringing together arts therapists, community, performing artists and professionals from different disciplinary spaces to re-consider what the arts can offer to people and communities when facing death, dying and loss. The event attracted 100 delegates and was supported by Scottish Partnership for Palliative Care, Queen Margaret University and Scottish Music Therapy Trust.

–D eveloped a new collaboration with Royal Scottish National Orchestra offering free online concerts to Hospice patients, families, carers, staff and volunteers.

– Had 533 attendances for art sessions, concerts and events.

The number of sessions provided by our team continues to increase year on year with a 66% increase in counselling services activity reported in 2020/21 when compared to the previous four year average. We adopted a blended model of virtual and face to face sessions to maximise efficiency of delivery service and continue to develop services to provide choices for those who access them.

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St Columba’s Hospice Care Annual Review 2020 – 2021

Trust

— Building relationships with solid foundations

We rolled out our new Hospice branding to enhance community awareness

Every year we’re humbled by the incredible generosity of our supporters and this year we’ve been blown away by the innovative and creative ways the people of Edinburgh and the Lothians (and beyond!) have found to keep fundraising and continue supporting us, despite restrictions.

Over the past 12 months we’ve faced the extraordinary challenge of sustaining services for patients and families while dealing with the impact of the pandemic on our revenue streams. The sudden and dramatic reduction of retail and fundraising income from charity shop closures and event cancellations continue to affect our fundraising efforts.

Our first ever virtual pet show proved a huge success, Douglas the border terrier was crowned the ‘Perfect Poser’

To minimise losses associated with these income streams we: –S ecured new sources of funding through Government Grants, Business interruption insurance and the Coronavirus Job Retention Scheme to offset the reduction in fundraising income.

–F urloughed staff where appropriate and benefitted from rates relief on our shop premises.

– Amended our investment and reserve policies to maximise investment returns and ensure the long term financial stability of the Hospice.

–D eveloped a diverse voluntary and retail income generation strategy to ensure flexibility and spread of income pathways.

– Embraced new technology to ensure all finance records are digital in order to comply with Making Tax Digital regulations.

Moving finance systems to

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be cloud based has enhanced accessibility for remote working.

– Further rolled out the new Hospice branding to our shops’ signage to enhance community awareness.

With most of our voluntary income channels either curtailed or stopped due to the pandemic, Trusts and Foundations became a very important source of potential income. We were therefore delighted when over 50 Trusts and Foundations responded very positively to our application for support during the crisis. A number of notable gifts were received from Trusts alongside increased giving from many of our regular Trust supporters.

A collective effort to secure support through our Scottish Hospices Together partnership resulted in a £1 million funding boost from Edinburgh-based

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Our supporters found creative and inspiring ways to raise vital funds for us despite restrictions

Baillie Gifford, global specialists in asset management and investment trusts. The much welcomed funds were split across the 12 members of the partnership to help support the increased need for hospice services across Scotland at this time.

Where possible we moved our events fundraising efforts online allowing our supporters to take part safely in their own time. Our first ever virtual pet show was a huge success with entries in categories including Sweetest Face, Perfect Poser, Caught in the Act and Most Like Owner.

The virtual event produced an unexpected social media star in the shape of Douglas the Border Terrier who amassed over 1,000 likes on our Facebook page.

We also launched our 7 Hills Challenge for corporate and community teams looking to take on the great outdoors. We had a fantastic uptake for the challenge with groups lacing up their hiking boots to take on the 7 hills of Edinburgh and enjoy the spectacular views of the city they offer. This new event raised over £17,000 and brought out the competitiveness in some with the fastest time being a jaw-dropping 2 hours and 34 minutes.

Our Summer Appeal focussed on the Hospice team still delivering the very best care to all of our patients, their families and carers in spite of the challenges we were facing and our supporters generous donations resulted in a slight increase on the year before with the appeal achieving nearly £24,000.

We quickly adapted our Giant Pub Quiz to an online version of the event hosted on Zoom

by Gooses Quizzes attracting 170 participants. Together with a second online quiz in November we raised nearly £5,000.

Our Light up a Life Christmas appeal went ahead virtually and although we couldn’t gather for the tree lighting ceremonies in Charlotte Square Gardens or Haddington House, we still hosted an online service to turn on the

lights with readings and a special performance by singer song writer Elle Exxe raising over £117,000 in the process.

Not only did the Adobe Foundation grant us $20,000 towards our Hospice at Home services but they also match funded the money raised by one of their employees Fiona McMiken, who also volunteers at the Hospice, when she was sponsored to chop 12 inches off her hair.

From virtual pub quizzes to art shows and gardening competitions, our community has never been stronger. We can’t thank everyone enough for their continued support.

Our Summer Appeal focused on our values and why they mean so much to us

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St Columba’s Hospice Care Annual Review 2020 – 2021

Respect

— Delivering high-quality care with empathy, respect and dignity

Education and Research Our education department provides a wide range of educational opportunities for students and professionals.

We also lead on a number of research areas which aim to improve patient care and empower our staff to deliver evidence based care.

During 2020/21 we: – Worked closely with Queen Margaret University to successfully transfer our academic courses online.

–C ontinued to publish articles in journals and books across nursing, medicine and the arts in palliative care influencing practices in a wider context.

–E xtended the academic partnership with Queen Margaret University through joint posts and joint research activity.

– Completed a collaborative research study with Marie Curie Hospice Edinburgh into the use of inpatient beds in the hospice setting. The findings informed the reshaping of our models of care and have been shared nationally with other care providers.

– Adapted to virtual methods of working to ensure business continuity. Our experience of using virtual consultation technology (ECHO) has been invaluable and enabled us to continue to support local care homes through an incredibly difficult period of time. ECHO networks have also been established with NHS Lothian volunteers, local homelessness support teams and the Art in Palliative Care community to further enhance their practice.

We transferred our all of our course materials online to give students access from home

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Our team published articles in journals and books across nursing, medicine and the arts in palliative care

– Utilised a research approach to evaluate the impact of the new hospice at home service.

– Were able to continue with the Biotech research study ‘Revolution’ which is evaluating the impact of living with advanced illness on the physical body and the person’s quality of life.

– Revised our MSc Person Centred Practice (Palliative Care) programme after it successfully completed its 5-year validation process, providing increased flexibility for our students.

– Delivered all teaching online in response to Covid-19 restrictions.

– Continued to contribute to the specialist interest groups (Dementia, Mental Health, Outcome measure, patient safety) in the hospice which focus on learning, development and collaboration on projects.

This enables staff from all departments to work together on different projects bringing learning and development into all areas.

We carried out collaborative research with Marie Curie Hospice Edinburgh into the use of inpatient beds in the hospice setting

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The Year in Numbers — Facts and figures from a busy year

Our total income was £8.45m, while our total expenditure was £10.77m 85p of every £1 is spent directly on patient care (with the other 15p going towards raising the next £1)

increase in counselling services activity* * based on previous four year average

Community Choir sessions

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inpatient bedrooms

admissions to our inpatient unit

online concerts

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St Columba’s Hospice Care Annual Review 2020 – 2021

volunteers

new referrals to our Community Hospice

advice calls taken by our Access Team

increase in number of patients and families supported* * based on previous four year average

arts and music sessions

people supported to die in their own homes

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live music sessions

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St Columba’s Hospice Care Annual Review 2020 – 2021

CEO’s Statement — Looking forward with hope and confidence

In over 40 years of the Hospice providing care and support across Edinburgh and the Lothians, this last year has undoubtedly been our most challenging yet. Palliative and end of life care doesn’t stop because of a global pandemic and I’m incredibly proud of the dedication and flexibility of our team in meeting those challenges head on.

While Covid-19 has caused us to challenge and change our way of working, having a strong understanding of our core organisational model has helped us to make positive, practical changes. Throughout 2020/21 we continued to develop, grow, and innovate our services – how they are delivered and how they are run – in support of our commitment to “Adapt to a Changing World”.

For example, by quickly adopting digital solutions, we enabled primary care to switch to online and video consultations.

Importantly, the increased need for support in our community

was evident quickly and we noted a swift change in community behaviour with far fewer people accessing care by attending the Hospice. We’re determined to explore how we can use the momentum of recent change to build a system that’s even better adapted to people’s needs, reaches everyone who needs our support and empowers people to be more in control of choices in relation to their own health and well-being.

We’ve learned a range of lessons that will be important as we settle into this new financial year and effective digital engagement is at the forefront. Our team

We’re building a system that’s even better adapted to people’s needs and gives more choices in relation to their own health and well-being

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Our community team has grown in terms of the geographical area they cover, the numbers of patients supported and the number of hours provided to patients

has embraced platforms such as Zoom and Teams to communicate effectively with each other but also to engage with stakeholders improving our approach to networking, learning from others and supporting others with information.

Collaboration and partnership have been key to maintaining our services and the unique circumstances have afforded us a moment to review how we can best reallocate our resources and use digital technology to provide the community with simple access to high-quality, timely care in other ways.

Over the course of the year our community team has grown in terms of the geographical area they cover, the numbers of patients supported and the number of hours provided to patients. The restructure of the team has resulted in many more people having the opportunity to receive end of life care in their own homes. In response to outpatients being unable to attend the Hospice in person, our clinical and counselling staff have integrated virtual consultations and support into daily service delivery, meaning everyone who needs it can access our services no matter where they are.

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Looking ahead, our aim is to build on the learnings we’ve gleaned through Covid-19 across our main areas of work so that we have modern services that truly meet and reflect our demographics’ needs. Our new strategy has been built on three key themes, Create, Empower and Sustain. These themes work together and often overlap, with the meeting point of all three areas being our central concern, the people we support and the workforce who make this possible.

With this in mind, over the next year we plan to: – Extend the hospitality service to run 7 days a week by introducing trained volunteers to the team.

– Extend on our Compassionate Neighbours support to include face-to-face relationships.

– In April 2020, the pandemic brought the need to immediately close day therapies and due to restrictions in group activities, it has remained closed since.

Our plan now is to take this

We’re extending our child and family support services to reach more families across Edinburgh and the Lothians

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St Columba’s Hospice Care Annual Review 2020 – 2021

We’re looking forward to being able to fill the Hospice with the love, warmth and happiness it has always had

opportunity to start afresh and move away from the traditional day model to a more responsive outpatient model of care providing a flexible choice of clinical and supportive care services as part of the Cedar Ward short stay unit.

– Commence delivery of outreach services from Haddington House.

– Develop the nurse-led model of care within the inpatient unit.

– Commence an international song writing project in collaboration with a palliative care unit in Greece.

– Deliver leadership awareness sessions across the organisation.

– Undertake the staff pay and reward modernisation project.

– Launch the QMU and SCHC Hub for Person Centred Palliative Care.

– Extend children and family support to the wider Lothian community previously unknown to Hospice.

– Pilot a new model of inpatient care with nurse led care beds and rehabilitation short stay beds.

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– Host a stakeholder event for health and social care professionals showcasing our strategic developments.

– Reintroduce face-to-face education, focusing on topics which facilitate engagement and discussion, supporting the learning process and linking it with practice. Initial sessions will centre around mental health, communication and direct clinical skills.

There is so much that St Columba’s Hospice Care has done and continues to do, to be extraordinarily proud of during this time. We have an excellent team, big-hearted supporters and a strong platform from which to adapt our operations to fit the changing landscape.

As always, I would like to extend a huge thank you for your continued support, we couldn’t do it without you.

– Continue developing interactive educational content and to review all mandatory training modules, courses and resources to increase engagement and offer more flexibility to our team.

– Invite external speakers from a range of backgrounds to do presentations, host discussions and encourage shared learning.

Amidst all the change and uncertainty we’ve experienced over the last year, one thing has remained the same, and that’s our commitment to serving the needs of our patients and their families. As we begin to regain a sense of normality, we’re looking forward to being able to fill the Hospice with the love, warmth and happiness it has always had, and for our community patients to be able to be surrounded by the people who matter to them most.

Jackie Stone, Chief Executive Officer

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Keep in touch with us online for our latest news: www.stcolumbashospice.org.uk facebook.com/stcolumbas @StColumbas

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@st.columbas.hospice St Columba’s Hospice Care 15 Boswall Road Edinburgh EH5 3RW 0131 551 1381 fund@stcolumbashospice.org.uk

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