Registered numb¢r.' 2184005 Charity number: 298164 THE HEART OF KENT HOSPICE (A company limited by guarantee) TRUSTEES, REPORT AND FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2022 THE HEART OF KENT HOSPICE IA company limit•d by guarantee) CONTENTS Page Refornn¢o and adminlstratlve dgtall¥ of the Company. Its Tru$tee¥ and Advls•r$ Trustoes. r¢port 3-16 Ind•p•ndent auditor5. Teport on the linancial statements 17-20 Consolidated statement of flnan¢lal actlvlties 21 Consolldated balance sheot 22 C¢mpany balance sheet 23 Con$olldated statement of cash flow$ 24 Notes to the finaneial st•t8m•nts 25-54 THE HEART OF KENT HOSPICE (A company Ilmlted by guarantee) REFERENCE AND ADMINISTRATIVE DETAILS OF THE COMPANY, ITS TRUSTEES AND ADVISERS FOR THE YEAR ENDED 31 MARCH 2022 Patron Marianna, Viscountess Monckton of Brenchley Trustws Mr J Barker-mccardle. Chair (resigned 17 May 20221 Ms A Mllllnglon lappolnleQ 8 November 2021} Mr C J Collins (resigned 15 SèptambÈr 20211 Mrs S G St C Cooper Mr R E Fadorcio OBE Mr G Hodnett Mrs E M Howe OBE Mr G Hunter, Deputy Chair Dr N Jegard Mr S R B Langworthy, Honorary Treasurer Miss S Pain Ms R Parris lappoinled 8 November 2021 } Mrs L Potts Ms E Price lappoinled 8 November 20211 MrHTBSmith Mr S Thompson {appDinted 8 November 20211 Ms L Vui lappoinled 8 November 2021) Company registered number 2184005 Charlty re9iStered number 298164 Rggistered offi¢• The Heart of Kent Hospice Preston Hall A￿eSf0rd Kent ME20 7PU Chiéf èxecutivè offiear Ms R Strèèt lappoint•d 22 Nov8mbèr 2021} Sonlor managomont team Mrs K Harrison. Pati&nt SeNices Director Dr G Parker MBBS ILondl FRCP. Lead Medical Consultant Ms A Kelly. Income Generation Director Mr S Webster, Finance Director (resigned 31 January 20221 Mis K Dackombe, Finance Director lappoinled 20 April 20221 Ind¢p•ndent auditors MHA Maclntyre Hudson Maidslone United Kingdom Bankers Barclays B8nk plc Fremlin Walk Maidstone Kent ME14 1QG Page 1 THE HEART OF KENT HOSPICE IA company limitsd by guarantee) REFERENCE AND ADMINISTRATIVE DETAILS OF THE COMPANY. ITS TRUSTEES AND ADVISERS (CONTINUED} FOR THE YEAR ENDED 31 MARCH 2022 Solicitors Cripps LLP Number22 Mount Ephraim Tunbrldge Wells Kent TN4 8AS Page 2 THE HEART OF KENT HOSPICE (A Company Ilmltgd by guaranteo) TRUSTEES. REPORT FOR THE YEAR ENDED 31 MARCH 2022 The Trustees present their annual rewrt together with the audited financial statements of Ihe group and the company for the year to 31 M8rch 2022. Tha Trustees confirm that the annual report and financlal statements of the company comply with the current slalulory requirements. the requirements of the companys goveming document and the provislons of the Slalement of Recommended Practice ISORPI, applicable lo charities preparing their accounts in accordance with thè Financial Reporting Standard applicable in the UK and Republic of Ireland IFRS 1021 leffgctivg 1 January 2015} as amended by Update Bullglln 1 leffecllve 1 January 20151. STRUCTURE, GOVERNANCE AND MANAGEMEMT Heart of Kent Hospice is a charity, number 298164 and a comp8ny limited by guarantee. number 2184005- ils Artidgs of Associallon constitute the governing documents. The principal areas of Charitable activity are the provision of specrdlist palliative care services in the heart of Kent area, including the boroughs of Maidslone and Tonbridge and Malling. These services include an inpatient unit. an outpatient centre, support therapies, a Hospice Hub programme. community semces. dementia services, ounselling. gducalion and training. and spiritual care. The governing document The Hospice is a company limited by guarantee and does not have share capital. The constitution of the Hospice is set out in the Articles of Association which were revised and adopted by Speaal Resolution by Members in November 2020 wSth the changes raJfied by the Charlty Commission in May 2021. The governan¢e strudur• During this financial year the Board of Trustees had four m8in sub commlttees whlch mel quart8rlw. Clinlcal Governance Commlttee. Flnance and Income Generation Committee, Govemance. Risk and Remunera￿On Committee and 8 Nominations and Trustee Development Committee. Due to the pandemic. mLtch of our business has been conduGled by way of video conference. with face-towface meetings restarting in 2022. The Board of Trustees is responsible and accoijntable for the governance of the Hospice,. rt met six times in the year. The Chief ExecutNe is responsible for the day-to-day management of the Hospice. Following the resignation of our Chief Executive, Sarah Pugh on 14 May 2021, the Board of Trustegs appointed our Finance DireGlor. RaGhel Street, as Interim Chief Executlve. Following a successful period as Interim Chief Executive, an inlerwew panel fomied of Tru8Èe8s and 8Xtemal parties appointed Fiachel Street as pemianenl Chief Executiv8 effecuve as of 22nd Novembor 2021. Charity governaneÈ eod• The Board has ftjll and careful regard to tha Charlty Governance Code and uses the code as its principal benchmath. The Board is committed lo continuous improvamgnt and development. R•cruitsnent and appointment of new Trustees One of the roles of the Govemance, Risk and Renumeration Committ99 is to recnjil. inéuct and train Trustees. This is delegated to the Ntsminations and Trustee Development Committee which is led by the Deputy Chair of the Board of Trustees. The Board actively promotes diversity and seeks Trustees from a range of backgrounds. Advertisements for new Trustees are published in the local press, on relevant websites, on the Hospice's Website. through local networks and in the Hospice newsletter if appropriate. Only Members of the Hospl¢e who a￿ ejected by the Board of Trustees Can be nominated as Trustees by the Governance, Risk and Romuneration Committee. The Trustees arè elected for a term of three yeaTS, renèwable for a further three years. The Chair is appointed for a fi￿year term. Page 3 THE HEART OF KENT HOSPICE (A company limlted by guarantael TRUSTEES. REPORT (CONTINUED) FOR THE YEAR ENDED 31 MARCH 2022 Jim Barker-mccardle stepped down as Chair and Trustee in May 2022, followng a successful five-year temi. The Tru$lees and Executive Team thanked him for his outstanding ieadership and seNice lo the Hosp¢￿. The Trustees appointed Ann Millington as the new Chair of Tiustges in May 2022. and they k>ok forward lo working with her. On 5 Juty 2022 our founding Patror). Marianna. Viscountess Monckton of Brenchley, sadly dled. Trfbules were paid to an inspirational. dedicated. and passionate lady who will be missed enormously by colleagues. volunteers and all who knew hor. Polici05 and procedures for th8 inductlon and tralnlng of Trustees The Hospice UK document enlitkd 'lnduclion of New Trustee5' as well as the Charity Trustee welcome pack published by the Charily Commission is used a5 8 model for Trustee induction and training. AJI Trustees receive a thorough induction and seek to ensure through the governance structure that the Board complies with best practice requirements. Trustee code of conduct The Board adheres to the Hospice's Code of Conduct for colleagues and volunteers. The Board takes its leadership role in upholding the values of thè Hospi￿ very seriously. The Bo8rd has adoptod the Hospice's culture framework and conducts itself in line with the Hospice's behavioural standards. The wider network The Hospice is a member of Hospice UK. The Chair and Chief Executive attend Hospice UK meellngs wlth other Chairs and Chiof Executives in the South-Easl Region and the Chief Executive ne￿orkS both locally and natlonally. The management team has w811 developed neiwork links with a wlde range of external organisa￿onS localty and nationalty. Risk managernent A risk manage￿ent framework is agreed annually by the Board. This includes a Risk Register which has been developod to idontify risks, mltlgations, and contingency actions. This Risk R@glster is revieweo and updated monthly by the Executive Team. Risks are revlèwed quarterly by the ￿levant Trustee Committee and quarterly by the Board of Trustees. On an annual basis, the Board agrees a risk threshold and prepares a risk appetite statement. It is recognised that this system can only provide reasonable Inol absolutel reassurance that major risks are being adequately managed. This year. the maln potential risks have conllnued to be Influenced by the ongoing impact of the COVID-19 pand8mic, induding the risks that.. Financial sustainability is wmpromised., Patient experience diminishes.. and straleglc goals not achieved Colleagues Ènd Truslees have worked closely together in the year to mitigate thes8 rSsks. Financial risks are mitigated by regularly reviewing our financial position through management accounts. cash flow modelling, reforecasting, and settlng long term financial plan5. Maintaining levels of patient experiences has been Ghallenging during th8 pandemic. in partlcular regarding visitin9, however usual visiting arran9ements are now re-lnslaled and outpatient seTvices have recommenced. Strategi¢ goals are set annually, and progress is monitored at Executive 8nd Board meetings. Page 4 THE HEART OF KENT HOSPICE (A company Ilmltsd by guarantee) TRUSTEES. REPORT (CONTINUED) FOR THE YEAR ENDED 31 MARCH 2022 OBJECTIVES AND ACTIVITIES The Hospice's objects, as set out In the Artic19s of Association are the relief of the need5 of those who are suffering from a chronic or teM)In￿ illness, disabilsty, or disease and in particular, but not so as to limit the gener81ity of Ihe foregoing, by.. a) the provlsion of an inpatient unit, outpatient cenlre, community servicé and bereavement service in the Kant and Medway area for such persons and thelr relatlves and carers.. b) to conduct. promote or encourage research into the care and treatment of patients wth progressive Ilfe threatening diseases and to publish thg beneficial results of any research undertak8n by the Charity., cl lo promote the principles and Practi￿ of palliatlV8 care throughout the wider community by assisting in mulli professional training and education., dl lo provide and facilltale the provision of physical. social. and psychological care and spiritual help for patients. relatives or carers under the care of the Charity and for the colleagues and volunteers working wlh them. Our vision Our vision is that evéryone limng with a temiinal illness in our community will achieve the best quality of life. We seek to achi8ve this by onabling pooplo with a terminal illness in our community lo live in comfort, with independ8nca and dignity to th8 and of thèir lives, and to support tho$e ¢10$08t to them. Our values and ¢ulture framgwork Our culture. values and behaviours guide our decision making and how w8 conduct ourselves in our work. They ensuro all palienls, and Ihgir familigs reoeive the very best care ijay in and day out. Our values are Compasslon. Integrity, Rgspeci and Teamwork. The Hospice has a culture framework whSch celebrates our values and helps colleagues and volunteers put these values into action. The culture framework includes four core behawours., I care, l own. I learfi. and I improve, vllh assoclaled behavioural standards whid) run through how we recruiL develop, and relain our team. Dlverslty and Incluslon The Hospice is Gommitted to being an equal opportunities employer. This Means that decisv)ns conceming all aspects of employment wll be based on the needs of the organisation and not any assumptions b8$ed on sex, race, age, disability. gender reassignment. sexual orientation, maryled or clvil partnership status, pregnancy or maternity. rellgion. or belief. All collaagues ar8 required to ablde by gquality. diversity. and inclusion principles. Foll¢)wing an external equality, diversity and inclusion audit in August 2020 the HOs￿Ce has continued to move forward wth the action plan based on the outcomes of this audit. particularly focusing on incluslvty. Th8 Hosplce is committed to providing skilled and compassionate care in a sUppO￿.ve environment based on mutual respect and trust. which recognises and values the difference of every individu81. ba they palignl. carer, colleague volunteer or visitor. The Chi8f Executive is the exa¢utive sponsor of this work and is supported by colleaguos in the Belonging Working Group. A membèr of the Hospice team is appointed as the Hospice's Freedom to Speak up Guardian and Ih&y support colleagues to speak up rf they feel that they ar8 unable to do so by othgr routes. Page 5 THE HEART OF KENT HOSPICE {A company Ilmited by guarantee) TRUSTEES. REPORT {CONTINUEDI FOR THE YEAR ENDED 31 MARCH 2022 Our slratsgic prlorltlgs Thè Charity's five strategic priorittes are.. 1. Local carè: We will establish a modal of local Hosplce support throughout our communilies. 2. Flexible, person centr8d caro: We will develop our servic8S SO that they can meet a wde range of patignt and family needs. 3. Speclalist ¢arg: We wlll prowde specialised care lo every patient end maintaln our reputation as a centre of excellence. 4. Skilled. compassionate care: We will be the organlsation of Ghoice for colleagues and volunleers. S. Care for our cause: We will enable our local ¢¢)mmunity to regard the Hospice as the local cause to support. Patient servlce5 provlded Heart of Kent Hospicè is a specialist palliative care and end of lifo care provider, which offers support lo patients with temiinal illnesses including those with dementia. It has beds for up to ten inpatients and an oulpatienl Hospice Hub for all patients and carers lo access. The Hospice currenUy cares for approximately 950 pallents and their carers at 8ny one lime in the community. The Hospice has embedded the use of outcome measures throughout 011 clinical areas using the Osjtcome Assessment Complexity Collaborative IOACCI national toolkit. This enables the clFnieal tearns to understand better patient and carer needs and measure individual and seNice outcomes for patients. The tools used as part of the OACC sulte enables support and care to be delivored 'at the right time. in the rlghl place by the right person." The Hospi¢e offers a range of services whith indud8'. Inpatient servlces The inpatient unit has 10 single ensuite bedrooms and provides 24tT Care for patlenls. all year. Patients are k)oked after in the inpatlgnt unit for a variety of reasons including= Short term 8s$esgmant and mgnagèmont ol pationts wth eompl8x arKllor unstable needs, be they physical, psychological, social or spiritual Rehabilitation and adaptation lo changes in fundon associated disease progression 8ndlor treatment Care in last days of life Emergency respits care Care after death Pag8 6 THE HEART OF KENT HOSPICE (A company Ilmltod by guarantsal TRUSTEES. REPORT (CONTINUED FOR THE YEAR ENDED 31 MARCH 2022 Ho$pi¢• Community Team The Hospice Community Team providGS high quality, seven day a week specialist palliative care advice for those patients with a progressNe life limiting illness who are being cared for al home or in a care home and to offer support lo their family, car8rs, and fTiends. The leaw has a skill mix of Nursas. Paramedics and Healthcare Asssstants, all who contribute to patients and Carers being seen at th8 right lime. in the right place by the rlghl person. They provide.. Cllnical assessm8nt and ongoing support to maximise symptom control Twice weekly drop-in sessions via the Hospice Hub Ilhese were paused during the COVID-19 pandemic) Oulpalient appolntments. home visits, telephone. or video assessments las appropriate under the COVID-19 pandemic reslri¢tionsl Advance care planning and support for patients their preferenGes and wishes Advice and support for external healthcare professionals Hospico Dementia Team The Hospice Dementia Team takes referrals for dementia patients earty on In thelr illness to enable advancg care planning and offering support and education to patients and carers. The Head of the Dementia Team FS supported by an experienced Clinical Nurse Specialist, Staff Nuyse, and Healthcare Assistant, and they 811 support patients and carers in their own homes or in care homes. They provide.. A monthly Dementia Cafe held in Magnolia Place oulpatienl centre Ilhis moved to a virtual café during th& pandemi¢l The Making Memories@ programme, which 18 a weekly, six-week dementla programme for patiènts and their carers A carer support group with soclal work support provbdlng pre be￿avement and post bereavement support for carers Formal and informal training for carers and healthcare professionals The mle of the Hospice Community and Dementia Teams a￿ both advisory and educational. The teams do not takè over the day-to4ay cara of thè patiènt bul providé spècialist palliativè carè advice and support for pat16nts. carets, and healthcare professionals. They have an in-depth specialist knowledge of the assessment and management of physical, psychological. emotional, social, and spiritual needs lo reduce symplorris, Suffering and distress, including CoMp￿X symptom management. The teams are also able lo support in analysing complex clinical decisions where medical and person81 interests are finely balanced, by applying relevant ethical and legal reasoning alongS￿e clinical assessment. They also pmwde multidisciplinary specialist advice, support. education. and trainlng lo the wder care team who Is providlng dlr6cl core level palliatsve care to the person. Famlly Support Team The Famity Support Team promdes counselling. soclal work for Children, young people and families. welfare advice and chaplaincy support. led by our Spiritual Lead with volunteer support, to all patients in the community and within the outpatient centre and inpatient unit This support is offered pre-ber9avement lo the patients andlor their carers, al thg timo of the death and into bereavement. Page 7 THE HE4RT OF KENT HOSPICE (A company limited by guarantee) TRUSTEES. REPORT (CONTINUED} FOR THE YEAR ENDED 31 MARCH 2Q22 Worklng in dose liaison with the primary health care team. the Family Support Team Pfovides-. Pre and post bertravement counselling Family and chIld￿n support Welfar8 support SpSritual Care Compassionate Neighbours Towards the end of 2021 the clinical teams reviewed the PTevlous Living Well model of oulpatlent services and agreed to change the offering to pationts and carers lo a more flexible and accèssible Hospi￿ Hub drop-in model. The Hospi￿ Hub programme is held in Magnolia Place within the Hospice and is as follows.. Monday & Thursday.. Dropin sessions no referr81 required for patients and ¢arers. This hub model provides a one-stop-shop to access support wllh syynptom and poin control. advance care planning, social support, spiritual, emotional, and welfaTe support. Tuesday.. The Dementia team fun Ihe Making Memories programme Wedn8sday-. Bereavement drop-in group 15 run, supporting families, and loved one's process grfef and bereavem8nt in so¢HI setting. Individual bereavement counselling is also available. Friday. Twic¢ a month, in partnership wth the Motor Neurone Disease Association (MNDAI. a drop-in group for patients ¥Mth Motor Neurone Disease is run. Salurd8y. Once a month a Dementia café is run in the Hospice for people Demèntla and their carers and loved ones to attend. Worklng in clos6 Ilalson wilh the prlmary health care team, the Famity Support provldes: Pre and post bereavement counselling Family and chlldren support Welfare support Spiritual Care Compassionate Neighbours Therapltrts Occupational therapy and physlolherapy can be offered to Hospice patients on the inpatient unlt through the Hospice Hub as required. Educatlon and dovelopment The Education Team provide internal and external clinical training including clinical statutory and mandatory tralnlng sessions. where the Educatlon Team supports colleagues to achieve the Hospice competencies and clinical Competencies as required. The Education Team also provide trainlng on all aspects of palfialive and end of lrfe care including providing multidisciplinary specialist advirE, support. education, and training to the nursing homes and other healtheare professlonals who are providing dIr￿t core level palliative care lo the person. They are part of the K&nt and Medway Collaborative for training and education and providè KCC lunded training for Care Homes. Page 8 THE HEART OF KENT HOSPICE {A company limited by guarantee} TRUSTEES. REPORT ICONTINUEDI FOR THE YEAR ENDED 31 MARCH 2022 Heart of Kent Hospice has become a regional provKler for Accredited Gold Standards Framework training for care homes and domiciliary care agencies and facilitates the European Cerbficate in Essential Palliative Care IECEPC} dlslance ￿arnIng course. which is aimed at helping professionals consolid81a and develop their palliatlv8 care confidÈnee and 8xp9thse. The course is also designed lo meet the needs of healthcare professionals new lo specialist palliabve care servlcas who wlsh to estsf>lSsh a strong foundatlon of knowledge on which lo build specialist knowledge and skills. The Education Team also supwrt the Head of Inpalent Unll to ensure the standards required to deliver outstsnding care on the inpalienl unil are mel. The Practice Development Nurse works with nurses on their induction. relum lo practrce. student nurses and the inpatient unrt team lo complete thgir practical 8n¢J theorelical competencies. The Hospice provides fvrther education via ECHO (Extension of Community Healthcare Outcomes) nelworks, ¥thich is a shared learning Zoom platform supported by Hospice UK. Th& Hosplce COVID-19 Respon$• 2021122 During 2021122. the Hospice continued lo respond to the COVID-19 pandemic, utilising and adapting the strategies and tools put in place in the prior year, such as daily Executive Team calls, weekly Heads of Department C811s and remote working to manage the risks lo our pattents, their famill8s, colleagues, and volunteers. During periods of lockdown. patient and earer face to face sessions, Dementia Café and Making Memories groups continued lo be provided as online sessions and dropin and outpatient appointments remained closed- only essential home visits were carried out and patients and carers were supported by the Glinical teams by telephone and by video link. The inpalienl unil continued lo admit patients and follo¥Mng indiwdual risk assessments Patient Care Volunteèrs continued to support the nursing t8am. Education and training sessions successfully continued to be delwered as online sessions vi8 video platforms. The education team worked wlh Kent and Medway Clinical Commissioning Group education platform lo produce training for care home prowders and visited care home5 to provide practical personal proleclive equipment IPPEI and COVID-19 swab testing training. Thè Patient Setvlces DIreCt￿ Jolned a daily local health economy ILHEI meeting which included all local healthcare providers whiGh look a system wide approach to information sharing and escalation of concerns. To ease the pressure on the acute trust tho Hospice liaised with the discharge team and Frailty Matrons to facilitatè inpatient admissKJns for appropriate patients. Into 2022 the LHE meetings continued on a Week￿ basis. As Govemmenl reslriclions were lrfted in 2022 the Hospice re-stsrted f8ce-lo-fa¢8 patient carer interactions, home vlslls, wunselling and vla the Hospice Hub and IPU visllor reslridons were relaxed. The large majorty of Hospice coll&agues, both patient facing and non-palienl f8cing took part in the COVID-19 vaccination programme receiving al least threa dos8s of the vaccine. Regular testing via lat8Tal flow tests and PCR tests conts'nue(l until April 2022 and a twice weekly lateral flow tesung regime remains in place. Page 9 THE HEART OF KENT HOSPICE (A company limited by guarantee) TRUSTEES, REPORT ICONTINUEDI FOR THE YEAR ENDED 31 MARCPI 2022 STRATEGIC REPORT ACHIEVEMENTS AND PERFORMANCE Quallty Assuranco Following a routine inspeGtion by the Care Quality Commission ICQCI In February 2017 the HosplGe achleved an overall rating of Outstsnding, gaining Outstanding in Caring and Responsive ¢Jomains and Good in Safe, Effectlve and Well led. Monthly CQC monitoring started during the pandemlc and is contlnuing as their model of inspgdon on n98d and risks identified. Patient services report qil8rterty lo the Clinical Govemance Commrtlea. Monthly cliniGal management and medicine5 management meetings tske place co¥&rlng topics such as safeguarding, audit, complaints. and incidents. An audit and research group meets every eight weeks, lo rev and monitor the core clinical audits and lo ensure the implementation of any actions or learning from audit findings. 11 also eneourages each clinlcal team to undertake al least two service specific audits per year. Monthly SPDt checks are carried out across clinical are8S to ensure quality and standards are maintained. Due lo the pandemic, the National Instltute for Health Research Clinlcal Res8arch Network {NIHR CRNI paused the sile setup of any new or ongoing studies al NHS and social care sile5 that were not nationally prioritised COVID-19 studies in March 2020. sIn￿ the nonurgent public health research studies have gradually resumed their activities, the Hospice has recruited 19 caregivers overall to the two followng national Portfolio Studies.. Measuring Outcomes of People with Demenlla and Their CaTers Qualitative Study of Experiences of Family Carers of People with Cancer Recelving Home Based - Palliative Carg Tha Hospice has established a devglopment framework lo support colleagues, personal Career development. Members of the senior nursing teams are supported to undertake Non-Medi¢al Prescribing and Advanced Assessment Skills training. We are also supporting one Healthcare Assistant lo complete the Nurse Associate Tralning. which is a roula into becoming a qualif5ed regislered nurse. In the Moncklon Education Centre, we deliver the Hospice's extem81 and intem81 programme of high-quality palliative and end of lrfe Care tTaining courses. Bespoke training is carrled out in nursing and care homes by the Education Team- this training can be supported bY-eXperien￿ days. on the inpatient unit. Senior Clinicians attend the Kent and Medway CCG End of Life Group meetings monthly to work in colLiboration with other agencies to formulate and implement a Kent and Medway CCG End of Life Strategy. The Patient Services Director and Head of Hospice Dementia Team attend all relevant sèctor groups including a Dementia Strategic Implementstion Group, a Cancer Improvement Group, and the West Kent Alllance Joint Programme Management Group, plus Frailty and Ageing Well stralggy meetings. The Patient Servl¢8s Director is co