Memorandum by Greenwich and Bexley Cottage
Hospice (PC 27)
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
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.
(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.
(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
(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.
(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
(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.
(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
(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.
(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
endeavoursFundraising 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
(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.