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Saint Francis Hospice

Saint Francis Hospice is the local hospice for outer east London, Brentwood and a small part of west Essex. We provide specialist palliative care for adults with advanced and/or progressive life-limiting illness who have complex problems, and work closely with GPs, district and specialist nurses, acute hospitals, domiciliary care agencies and care homes for best symptom control, emotional, psychological and spiritual support. Our patients are predominantly (but not exclusively) in their last year of life. Most care is at home (including care homes), but we also have day therapy unit, outpatient and group support for people who can journey here. We have an 18 bedded short stay inpatient unit for people with complex needs who need 24/7 multidisciplinary assessment and care. Carer/family support is a key focus. We are the main local provider of education/training in advanced illness/end of life care.

Updated:
23 July 2015
Location:
London
Sectors:
Care, Health, Retail
Local Alliances:
Havering Dementia Action Alliance

1. Action Plan

1. The National Dementia Declaration lists seven outcomes that the DAA are seeking to achieve for people with dementia and their carers. How would you describe your organisation’s role in delivering better outcomes for people with dementia and their carers?

Our key role is in championing best end of life care so that people in our locality living with serious illness are recognised, and receive timely, skilled, confident, thoughtful care through the last years of life and in the dying phase.

This through

  • working closely with and sharing expertise with others
  • providing experienced advice and support concerning palliative care , 24/7
  • supporting patients who have problems which are difficult and outstrip the support abilities of the primary care team
  • recognising dying, and providing additional support through dying
  • ensuring that our staff are understanding of a wide range of life limiting illnesses and the difficulties they bring
  • championing person-centered care
  • championing the needs of vulnerable adults with regard to access to care/ their voice in their care
  • helping carers by identifying best support, to maintain resilience
  • helping (and empowering) patients, families, carers to talk about their concerns for the future/what they want in the future whilst they are able 
  • facilitative role in helping people who no longer want or who no longer benefit from hospitalisations to stay out
  • educating, training and supporting front line workers in end of life care

2. What are the challenges to delivering these outcomes from the perspective of your organisation?

  • Gaps in our knowledge of resources already there/being developed to help and support people with dementia, and their families. As a key local resource for advice we need to be more knowledgeable about sources of care and support at every stage of the illness journey
  • Our understanding of what others need to ensure that they are secure in their care in advanced dementia illness. This has begun but is at early stage
  • Our staff and volunteers’ understanding of the challenges of living with dementia for patient and carer. Their security in managing complex challenges e.g. disorientation and behavior disturbance sensitively and with understanding
  • Our clinical care team identification of and best support of dementia +/- delirium without loss of personhood
  • Our experience that by the time we meet people with dementia their capacity to share what they want towards end of life has been lost.

Member website

www.sfh.org.uk

2. Actions

  • Development of a ‘Local Resources for People Living With Dementia’ pack for hospice advice line staff and for the hospice Family Support Services team

    We receive many calls asking us where to turn to for help in living with a wide range of life limiting conditions, including dementia.

    Concerning dementia, calls asking for help come from a variety of sources, e.g.

    • carers of people whose primary diagnosis is dementia
    • carers of people who have a serious illness AND dementia
    • people with a serious illness who care for someone with dementia
    • people with dementia who fear for the future and need help with this

    By using existing links with partners in care (e.g. Alzheimer's Society, Age UK, Healthwatch) and forming new local links, we will put together a pack to help our advice line nurses and also our Family Support Team to be able to give up-to-date advice about good local supports that can help people living with dementia. 

    The making of the pack will help with connecting us locally to partners in care and will enable us to highlight our own value as experienced end of life care providers interested in and concerned to get it right for people with dementia.

    The pack to be updated as one of the 6 monthly responsibilities of our hospice dementia champions.

    Status:
    Completed

    2015 - Third Quarter Update

    This is all done.  It will need quarterly updating, but is proving very valuable.  We know who will update this from within, with good connections to colleagues and partners & external stakeholders.

    2014 - Fourth Quarter Update

    New member

  • Facilitating earlier and informed advance care planning discussions by partnering with our local Memory Clinics

    The hospice and the NELFT Memory Team have already recognised that for someone diagnosed with dementia timely discussion about the future, including fears about the future, what help might be needed/who can be there to deliver that help and the value of identifying their wishes for the future are important.

    We have realised together that this is an area that the Memory Team is struggling with, and that this is an area the hospice is very familiar with.

    The Memory Team has thus commissioned training on advance care planning and on end of life care for their team. We are delivering the training. We have put together a programme of training over 2 days. Day 1 will focus on principles and practice of palliative care/end of life care. Day 2 will work on grief and loss, difficult conversations and the value of/how to introduce advance care planning. This to be delivered at end 2014. We will develop a tool to explore whether/what difference the training has made to practice.    

    We have developed a BSc module: 'Dementia - the contribution of End of Life Care' for Southbank University. This will run for the first time in early 2015.

    Status:
    Planning

    2015 - Third Quarter Update

    We have completed the commissioned training on advance care planning and on end of life care for the Memory Team.

    We are still developing a tool to explore whether/what difference the training has made to practice.  

    Regarding the BSc module developed: 'Dementia - the contribution of End of Life Care' for Southbank University. This has run and went really well.  We had very positive feedback and we now have a Dementia special interest group on our inpatient unit to help us develop our understanding in supporting people with dementia on the unit, also family members who have dementia. 

    2014 - Fourth Quarter Update

    New member

  • Hospice staff and volunteer training to ensure a Dementia Aware organisation (including our shops). Development of the hospice’s clinical staff in dementia care skills

    Plan: to develop and deliver a sustainable Mandatory Training Programme to reach all hospice and hospice shops staff and volunteers.

    For 2015/16 Mandatory Training cycle, then for all staff/volunteers via induction training.

    Requires identification of committed champions across our volunteer and staff workforce, then their training to become trainers who can the roll out training across the organisation via our MT programme/new staff/volunteer induction programme

    Plan: to develop and deliver clinical staff training via a ‘back to back’ training programme (duration 2 hrs), to ensure that all hands on staff are up to date with understanding/practice for best care delivery for people with dementia, delirium, cognitive impairment.

    Requires identification of learning needs (through joint working with already identified external partners who work regularly with people with advancing/advanced dementia) then development of a programme and successful delivery and ongoing work with staff to ensure that skills are sustained.   

    Status:
    Planning

    2015 - Third Quarter Update

    Almost all staff across the hospice and shops have now done their dementia friends awareness session and clinical staff reps went to the BSc module - stimulating a special interest Group (as above) to work with our Community SFH CNS Clinical Champions to continue to develop us all.

    Of interest, we are supporting many people with dementia at home and in the NHS at the very end of life (last few days) in conjunction with their families, friends and care staff, and as a result of an audit we are now making sure we do connect with family of people with dementia in care homes who are dying, to make sure that everyone is in the loop and being heard, and supported. That has made a big difference both to families and to care home staff, and was a great example of audit leading to learning, and service improvement-which has made a difference. 

    2014 - Fourth Quarter Update

    New member