ASHGATE HOSPICE
SERVICES & REFERRAL INFORMATION
INTRODUCTION
Ashgate Hospice provides specialist palliative care and support to patients with a life-limiting illness and their families/carers. The hospice provides care for adults who live in and/or who have a GP based in North Derbyshire – the area previously covered by the Chesterfield, North East Derbyshire and High Peak Primary Care Trusts.
The hospice opened in 1988 and since that time the services provided have been extended considerably. Last year over 1000 patients and families received care and support in their own home and over 350 patients were admitted to our In-Patient Unit.
The multi-disciplinary team consists of specialist doctors (led by Consultants in Palliative Medicine), nurses, pharmacists, physiotherapists, occupational therapists, social workers, chaplain, lymphoedema nurses, psychologists and the family support team. They have undergone additional training and education and have appropriate experience to enable them to provide this specialist service.Care and support is provided in a variety of settings, including:
- Community – home, nursing & residential home, community hospitals
- In-Patient Unit
- Day Centre
- Hospital – Chesterfield Royal
- Out-patients
Although historically known for the support it gives to patients with cancer, 15% of our patients have other life-limiting illness. We are very keen to increase this aspect of its work and links have been made with specialists in other fields. For example, the British Heart Foundation nurses hold an out-patient’s clinic at the hospice and monthly MDT’s. We also provide support to Blythe House Day Hospice in Chapel en le Frith, including the Consultant in Palliative Medicine, Physiotherapists, Occupational Therapists and Social Workers.
If you have not had an opportunity to visit the hospice we would be very happy to show you round and discuss the services we provide in more detail. We would also be happy to discuss how you think we could develop our services and work together in the future.
Team managers include:
Mrs Kathy Hollyer – Chief Executive
Dr Sarah Parnacott – Consultant in Palliative Medicine
Dr David Brooks – Consultant in Palliative Medicine
Mrs Margaret Borrell – Head of Nursing Services (Hospice)
Mr Tony Reid – Head of Nursing Services (Community & Hospital)
Ms Claire Blakey – Macmillan Community and Hospital team manager
Miss Emma Wright – Therapy Services Manager
Mrs Lynda Parrish – Lymphoedema Services Manager
Mr Paul Scrogie – Social Work Team Manager
Mrs Tracey Brailsford – Family Support Co-ordinator
Mrs Sue Crabtree– Manager In-patient unit and day centre.
Mrs Jane Irani – Professional Development Adviser
Attached is some information on our services. Further information is available from the hospice on 01246 568801 or our more detailed information leaflets.
COMMUNITY SERVICES
The hospice provides a variety of services to patients and their families/carers in their own home (including residential or nursing home). The team includes the Community Macmillan Clinical Nurse Specialists, Home Care Support Workers, Hospital specialist palliative care team, Physiotherapists, Occupational Therapists, Lymphoedema management, Social Workers and Family Support Team. Domiciliary visits and/or out-patient appointments by a member of the medical team may also be arranged.
Community Clinical Nurse Specialists (Macmillan Nurses)
Introduction
This service is provided by Community Clinical Nurse Specialists (Macmillan Nurses) who have undergone specialist education and training and have appropriate experience to enable them to provide a specialist service.
The service provides specialist advice and support to promote the highest quality of life attainable for individuals with cancer and other life limiting illnesses within their family/carer setting.
Through specialist advice and education the service also provides support to the Primary Health Care Team and other professional colleagues including those in community hospitals and nursing homes.
The Macmillan Nurses each have links with specific GP practices but working as a team they share workload when required to ensure continuity of care.
Service Availability
This service is available Monday to Friday 9am to 5pm. Appointments outside these hours may be negotiated with individual team members.
Out of hours advice is provided by the on call Specialist Registrar or Consultant in Palliative Medicine.
Referrals
A referral to the Macmillan Nursing Service can be made by anyone. However, the team will consult the Primary Healthcare Team and assess the level of specialist support required.
Referrals are accepted by phone, fax or letter and following prioritisation, the Macmillan Nurse will make contact on the same day for urgent referrals and within 2 working days for all other referrals. We also:
- Inform the primary health care team of the Community Macmillan Nurse Specialists involvement following the initial referral.
- Undertake a specialist assessment with the patient in order to manage identified problems within 5 days of contact.
- Following the assessment and discussion with the patient and/or carer and referrer and primary health care team agree on continued plan of care and monitoring
Home Care Support Team
Introduction
The service aims to provide support and respite at home in order to promote the highest quality of life attainable for individuals with Cancer and other life limiting illnesses.
Service Availability
This service is available Monday to Friday, 8.30am to 5pm. Crisis prevention support is (dependant on resources) available outside these hours on request from a District Nurse or Macmillan Nurse and is organised by the Hospice at Home Co-ordinator.
Referrals
Referrals are normally made by the Specialist Palliative Care Team. The Primary Health Care Team may also refer direct to the service, however, the Head of Nursing Services (Community & Hospital) will assess the appropriateness of the referral before the patient is accepted.
The Home Care Support Team work with the Primary Healthcare Team, statutory services, healthcare agencies and other voluntary organisations to assist patients to be adequately cared for at home, when this is their wish.
The Service includes:
- Providing help to patients and their families/carers in their own homes
- Providing support and respite for families/carers
- Helping prevent crisis admission to hospice and hospital
- Assisting discharge home from hospice or hospital
IN-PATIENT UNIT
Introduction
The In-Patient Unit provides specialist palliative care, treatment and support for adults, who have a life-limiting illness. Patients and their families have access to all the multi-disciplinary team, including the specialist doctors (led by Consultants in Palliative Medicine), nurses, physiotherapists, occupational therapists, social workers, chaplain, lymphoedema nurses and the family support team.
Patients may be referred for:
a) Symptom control - assessment and management
b) Terminal care
Referrals
Referrals to the in-patient unit may be made by the patient’s General Practitioner or Consultant (or by any health professional on their behalf).
Referral to the In Patient Unit may be made in writing or by telephone to any member of the admissions team. The team consists of the Head of Nursing Services (Hospice), In-Patient Unit Manager and Consultants in Palliative Medicine.
In the absence of the admissions team the referral is taken by a senior nurse on the In-Patient Unit and passed on to a member of the admissions team as soon as possible.
Referral for admission on Bank Holidays and weekends are relayed to the Specialist Registrar on call for discussion with the Consultant in Palliative Medicine. Patients are not routinely admitted during the evening/night.
DAY CENTRE
Introduction
The Day Centre provides specialist palliative care and support to patients with life-limiting illnesses. Patients attending Day Centre and their families/carers may also access telephone support and advice as necessary. The Day Centre is able to accept 16 patients per day.
Service Availability
The Day Centre is open Tuesday to Friday, with patients normally attending for one session per week.
Referrals
Any member of the Specialist Palliative Care Team, GP or District Nurse may make referrals to the Day Centre. Referrals are accepted Monday to Friday, 9am to 4.30pm.
Referrals are discussed by the Day Centre Sister and Consultant and places offered, initially for a period of 6 weeks.
The Day Centre provides the following services:
- Nursing care and medical assessment
- Physiotherapy and Occupational Therapy
- Diversional Therapies
- Practical support and advice, e.g. benefits advice
- Psychological and emotional support
- Spiritual support
- Some medical treatments
- Access to equipment needed to help at home
- Dietary advice
OUT-PATIENTS
Introduction
Out-patient appointments are offered by most members of the multi-disciplinary team.
Service Availability
Appointments are available during normal working hours.
Referrals
Referrals for out-patient appointments should be made direct with the member of the multi-disciplinary team required or with the medical secretaries
HOSPITAL PALLIATIVE CARETEAM
Introduction
A team of four clinical nurse specialists employed by Ashgate Hospice are based at Chesterfield Royal Hospital. They work closely with the Consultant and Specialist Registrar in Palliative Medicine.
The team provide specialist advice and support to patients and their carers and endeavour to bring the specialist care provided by the hospice, into the acute setting, thus allowing people with life limiting illnesses to have the highest quality of care available, irrespective of environment.
Service Availability
This service is available Monday to Friday during normal working hours.
Wards are informed of the out of hour’s service that is available via switchboard.
Referrals
Referrals are accepted from the ward medical teams, or through Ashgate services.The majority of patients are seen on the day of referral for specialist assessment of their needs.The team will also accept referrals from the GP when their patients are admitted.
The team is actively involved in discharge planning to support patient choice and enable people to return home. Working alongside the Consultant and Specialist Registrar, a Palliative Care Outpatient clinic is held at the Royal on a weekly basis, thus allowing more people to stay in their own homes, knowing they have a regular specialist follow up appointment.
In addition, through specialist advice and education, the team provide teaching sessions for staff on both a formal and informal level and work closely with the Royal in end of life matters, developing the Last Days of Life Pathway used at The Royal.
The team visits the Emergency Management Unit, each morning to see if they have any patients with specialist palliative care needs. This may involve arranging urgent transfer to Sheffield Hospitals, or for transfer to Ashgate.
PALLIATIVE MEDICINE
Introduction
The medical team includes two Consultants in Palliative Medicine, supported by Specialist Registrars, F1 and F2 Doctors and Clinical Assistants (GPs with a special interest in palliative medicine).
The team provides Specialist palliative medical support and consultancy to the service and wider healthcare community across all care settings.
Service Availability
The consultants and doctors are contactable during normal working hours through the hospice.
The team ispart of the Sheffieldon-call rotation, ensuring that specialist doctors are on call out-of-hours.
Out of hours contact with the on call specialist registrar or consultant can be made through the Chesterfield Royal switchboard or via the hospice.
Referrals
The medical team sees patients and their families/carers in all settings, as appropriate, including community, in-patient unit, day centre and hospital. The doctors also provide support and advice to members of the primary care team.
PHYSIOTHERAPY
Introduction
This service is provided by the Therapy Services Manager, Specialist Palliative Care Physiotherapists and Technical Instructors.
The service aims to provide symptom management and rehabilitation utilising a range of treatments, focusing on improving/ maintaining the patient’s quality of life.
Service Availability
The service is available Monday to Friday during normal office hours.
Appointments outside these hours may be negotiated with the therapist. Patients may be seen in their own home, in the Day Centre, in the Inpatient Unit, as out-patients or at Blythe House Day Hospice.
Referrals
Any member of the Specialist Palliative Care Team can make a referral to the physiotherapy service. Referrals from the Primary Health Care Team, hospital teams and social services may also be made direct to the service. However, the Physiotherapist must agree that there is a need for the specialist service.
The service provides assessment, treatment planning, implementation including use of acupuncture and evaluation on an individual patient basis. A patient may be referred to the physiotherapist for assistance with a variety of problems such as:
- Poor mobility
- Poor limb function
- Pain
- Anxiety affecting mobility/breathlessness
- Breathlessness
- Fatigue management
- Simple Oedema
OCCUPATIONAL THERAPY
Introduction
This service is provided by the Therapy Services Manager, Specialist Palliative Care Occupational Therapists and Technical Instructors, and the Therapy Drivers.
The service aims to promote patient independence for as long as possible, focusing on improving/ maintaining the patient’s quality of life.
Service Availability
The service is available Monday to Friday during normal office hours. Appointments outside these hours may be negotiated with the therapist. Patients may be seen in their own home, in the Day Centre, in the Inpatient Unit, or at Blythe House Day Hospice.
Referrals
A referral to the occupational therapy service can be made by any member of the Specialist Palliative Care Team. Referrals from the Primary Health Care Team, hospital team and social services may also be made direct to the service.
The Occupational Therapists provide advice for patients, family and professional carers on the appropriateness of equipment a patient may need to maintain their independence and quality of life.
This may include equipment:
- to assist with activities of daily living
- for the relief of pressure
- for safe moving and handling
- wheelchairs
or advice on
- managing fatigue
- managing breathlessness.
In certain situations where homes meet specific criteria Ashgate Hospice are able to assess and arrange for the installation of stairlifts.
MACMILLAN LYMPHOEDEMA TEAM
Introduction
The Macmillan Lymphoedema Service provides treatment, support and care to patients suffering from either primary or secondary lymphoedema. Patients do not have to be suffering from a life-limiting illness to access the service.
The service is provided by the Consultant in Palliative Medicine, specialist lymphoedema nurses and a lymphoedema healthcare technician.
Service Availability
The service is available Monday to Friday during normal office hours. Patients may be seen as out-patients at Ashgate Hospice or Blythe House Hospice, in their own home, in the Day Centre, or in the In-patient Unit.
Referrals
A referral to the Macmillan Lymphoedema Service can be made by any member of the Specialist Palliative Care Team. Referrals from the Primary Healthcare Team may also be made direct to the service.
The usual response times are:
- Cancer Palliative care - 2-4 working days (Hospice In-Patient Unit 1 working day)
- Cancer Lymphoedema - 2weeks
- Non Cancer Lymphoedema - 12-16 weeks
The Lymphoedema service provision includes:
- Initial medical and specialist nurse assessment, treatment planning and education.
- Patient review
- Manual Lymphatic drainage
- Decongestive lymphatic therapy
- Garment supply and fitting
The Team provide support, training and advice to:
- Other professionals within the Specialist Palliative Care Team
- Primary healthcare professionals
- Hospital healthcare professionals
SOCIAL WORK
Introduction
The Social Work Service/Palliative Care Assessment Team is provided by social workers/care managers who have received additional education and training in palliative care issues.
The role of the team is to promote the rights of patients and their carers by providing advice on services available to them, which includes advice on maximising people’s financial circumstances. The Social Work Team also provides emotional support for patients and carers.
Service Availability
The service is available Monday to Friday during normal office hours. Appointments outside these hours may be negotiated with the individual team members. Patients and carers may be seen in their own home, in the Day Centre, as out-patients or in the In-patient Unit.
The Social Work Team work within the following timescales;
- To make contact within 24 hours of receiving the referral, and
- To have commenced assessment of a patient’s needs within 5 working days
Referrals
A referral to the social work service can be made by any member of the Specialist Palliative Care Team. Referrals from the Primary Healthcare Team may also be made direct to the service. The social workers must agree that there is a need for the specialist service before the patient is accepted.
Referrals are received by phone, fax or letter (and incorporate the new “Single Assessment Process” and subsequent new documentation).
The social workers work within the Derbyshire Social Services’ Framework for access to and provision of social services and benefits. They have available, for patient and professional use; a range of information leaflets on the statutory and voluntary services/ benefits available in North Derbyshire and HighPeak and Dales.
Services include:
- Offering/conducting full needs assessments to include collecting assessments from other professionals involved such as Macmillan Nurses, Consultants etc.
- Advising patients, family/carers and professionals, on the appropriateness and availability of social service support for patients who are to be cared for in the community. They co-ordinate mainstream discharge packages, working with and referring patients for care management as appropriate.
- The social worker will liaise with other agencies in order to obtain the services required to support the patient in their own home.
- For patients who are unable to return home because of their personal circumstances, but do not require continuous specialist inpatient care, the social worker will work with the patient and family/carer in order to find suitable accommodation in a residential or nursing home.
- Advising on the benefits available to patients and family/carers.
MACMILLAN FAMILY SUPPORT TEAM