The Mary Stevens Hospice Trustees and Directors Annual Report including consolidated audited financial statement for the year ending 31 March 2023
## Care | Compassion | Kindness
The Mary Stevens Hospice Limited, Registered Charity Number 517656. Registered Company Number 1963989 (England and Wales)
**The Mary Stevens Hospice Limited Annual Report 2022/2023**
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||**Table of Contents**|
|---|---|
|**O1**|Contents|
|**02**|A word from our Chair|
||Brief Financial Overview|
|**03**|Clinical progress overview|
||A word from the CEO|
|**04**|Meet the Trustees|
|**06**|Charity Governance|
|**10**|Summary of Main Activities|
|**11**|Strategic Report|
|**12**|In Patient Unit|
|**15**|Medicines Management|
|**16**|Day Unit Activity|
|**18**|Trusts that supported us during 2022/23|
|**20**|Equity, Diversity and Inclusion|
|**24**|Bereavement Services|
|**28**|Key achievements from education perspective|
|**30**|Social Work|
|**32**|Spiritual Care|
|**34**|Volunteer Service|
|**36**|Fundraising|
|**40**|Lottery|
|**41**|Trading Report|
|**42**|Structure, Governance and Management|
|**43**|Reference and Administrative Details|
|**44**|Reserves Policy|
||Investment Policy|
|**45**|Going Concern|
||Trustees / Directors Indemnity Policy|
|**46**|Financial Reviews|
|**47**|Statement of Trustee Responsibilities|
|**48**|Accounts|
## **A word from our Chair**
Hello and welcome. It gives me immense pleasure to invite you to read the Trustees Annual Report. Also, my thanks to all who have made significant contributions to the report.
The opening forward and commentary provided by Vice Chair John Turner and Chair of Clinical Standards Dr Jane Bridgewater-Flint gives you a brief insight into the financial and clinical landscape of the Hospice.
2022/23 was another challenging year during which the support of all our staff, volunteers and funders helped us to continue to deliver excellent service for our patients and their loved ones undertaking and delivering success after success. It would be remiss of me if I did not acknowledge the No Barriers Here© project which has achieved a broad spread of interest across the health economy both locally and nationally. The focus on equality, diversion and inclusion can benefit the organisation and attract
a wider pool of talent. Equally important is the opportunity to embed the chance to raise staff satisfaction and a feeling of belonging and enhanced creativity.
Post Covid the Senior Leadership Team are developing plans to increase the core business provision in the community and the local health economy. It is clear to me we have the appetite and ambition – we want to lead the way in making lasting positive contributions for the communities we serve.
Finally, from me, my sincere gratitude to my fellow Trustees for their invaluable expertise and guidance in supporting this wonderful and outstanding organisation.
_**Peter Marsh** Chair of Trustees, The Mary Stevens Hospice_
## **Brief Financial Overview**
The year ended 31 March 2023 saw a deficit of £382,305, compared to a deficit of only £309,000 the preceding year. As much of the deficit relates to the depreciation of the Hospice’s fixed assets and unrealised losses on investments, the Hospice’s cash position nevertheless saw an improvement.
The Hospice succeeded in growing its total income from all sources, with particular success in achieving support from charitable trusts. However, the increase was insufficient to match the increases in costs. The cost pressures, particularly in relation to salaries, the Hospice’s principal cost, were largely driven by external factors such as increases in the National Minimum Wage, NHS terms of employment and the inflationary consequences of the war in Ukraine.
2024 will show a further increase. The local NHS Commissioners have also now acknowledged the need to provide further funding to the Hospice and although the amount and timing remain uncertain it is an encouraging sign for the future.
More details of the financial position are included in the Financial Review and in the attached detailed audited accounts.
## _**John Turner**_
_Vice Chair of the Trustees_
Fortunately, the Hospice benefited from an increase of almost £100,000 in legacy income and from an increase in donations. It is also already clear that legacy income in the year to 31 March
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## **Clinical progress overview**
It has been a privilege to Chair the Clinical Standards Committee since first a Trustee in 2015, and am proud of our reach across the medical community in welcoming Palliative Care Consultants and other relevant Specialists to advise and work with us as we move to establish a specialist care model. We are particularly grateful to our Acute Trust Medical Director, Dr Julian Hobbs, who has generously taken on a Governance role with us before an eventual Consultant appointment is made. Following our Outstanding CQC rating in 2020, significant initiatives have
been pursued in ward management, specialised day care clinics, “No Barriers” leadership, grants for new services, and strategic development for sustainability. A continuing educational approach as we optimise governance processes ensures we learn from all, and aspire to be an example of excellent practice in end of life care. Integrated audits and research towards continually improving care, form our current priorities.
## _**Dr Jane Flint Bridgewater**_
_Chair of Clinical Standards Governance Committee_
## **A word from the CEO**
It gives me immense pleasure to present this report to you and share both the successes and challenges that the hospice has faced during the past 12 months.
As an independent Hospice registered with both Companies House and the Charity Commission, I am pleased to report that we have experienced a year with minimal disruption from Covid 19 on clinical services.
However, the year has not been without its challenges, in part due to the financial legacy of the pandemic. Widespread economic pressures impacted negatively on income generation. The rise in inflation, interest rates and fuel costs have all negatively affected the cost of living. Significant financial hardship has affected both businesses and individuals, which we have seen reflected in falling donations to the Hospice.
We are thankful to have experienced significant growth in legacy income, which is forecast to carry on through the next budget year. Trustees and the Senior Leadership Team have supported a more focused strategy on investing in the growth of legacies moving forwards.
The level of statutory funding received from our Commissioners remains significantly lower than the national average, which negatively impacts on our capacity to grow Hospice services. A business case from the Hospice was accepted by
the Black Country ICB (Integrated Care Board) during this reporting year to place the Hospice on their cost pressures register. Reforms within the Health and Care Act 2022 put into statute the requirement for ICBs to commission core and specialist palliative and end of life care services. As a Hospice we have been migrated to an NHS contract, but the levels of funding attached to these contracts in the future are still uncertain.
During the latter part of the reporting period, the Hospice engaged in an independent peer review of its clinical governance. This review was to evidence the safety of the standards of governance as part of the recruitment process for a Palliative Medicine Consultant. This work spans into the following budget year but was essential in ensuring the Hospice could provide specialist palliative care to people with complex issues within the local healthcare system.
It is a privilege to lead the team at Mary Stevens. The work ethics and values of care, compassion and kindness upheld by our employees are exemplary.
I thank everyone who contributes to making our work possible.
## _**Claire Towns**_
_Matron and CEO_
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**Meet the Trustees**
## **Peter Marsh (Chair)**
## **Nigel Dace**
_resigned 16 May 2023_
Peter’s career spanned 44 yrs working in the NHS managing Major Capital Development, the last 15yrs of which Peter was responsible for delivering non-medical facilities over multiple sites. Peter was appointed a Magistrate in 1997. He now chairs Fundraising Governance Committee.
## **John Turner (Vice Chair)**
Originally from Hereford, John obtained a degree in theoretical physics before qualifying as a Chartered Accountant, specialising in taxation, and subsequently becoming a partner in Deloitte. Formerly the treasurer of Stourbridge Tennis Club and a West Bromwich Albion season-ticket holder. He Chairs the Finance and Resources Committee for The Mary Stevens Hospice.
## **Brian Blakemore**
Brian has over 40 years’ of experience in financial services covering Corporate Banking and Private Equity. He has a range of nonexecutive positions covering venture capital, corporate finance, private equity and online retail. From 2020, Brian has been the Chair of Trading Board of Mary Stevens Hospice.
## **Spencer Hodgson**
Before retiring, Spencer had 30 years experience as a senior manager, gaining a mix of commercial, operational and administrative/ financial experience gained across a range of industries and company sizes in the private and semi-public sectors. Spencer has been a fundraising volunteer for Mary Stevens Hospice and is a member of the Finance and Fundraising Governance Committees and a Director of The Lottery Board.
Nigel worked as a Solicitor in private practice for over 40 years, retiring in 2015. During the next year he became a Trustee of Mary Stevens Hospice and values considerably the high regard in which the Hospice is held within and beyond the Stourbridge community. He serves on the Governance and Clinical Standards Committees.
## **Steve Waltho MBE**
Steve is a Dudley Councillor and former Mayor of Dudley with 21 years of public service to date for which, along with a lifetime of charity fundraising, he was awarded the MBE in 2018. He has also served on Health Boards in various capacities and currently serves on both the Fundraising and Trading Board Committees at Mary Stevens Hospice.
## **David Martin**
David is a Chartered Accountant with over 30 years’ of experience working as an accountant in industry and now in practice. Many of his clients are owners of SMEs who he helps to understand the numbers and this experience is proving to be invaluable in his roles as a Trustee of Mary Stevens Hospice and as a member of the Resources and Fundraising Governance Committees.
## **Karen Shakespeare**
Karen has 25 years’ experience as a Customer Service Manager in the Manufacturing, Utility and Logistics industry. She has served as a Councillor on Dudley Council for the past 19 years, much of that time as the Cabinet Member for Environment.
## **Dr Jane Flint Bridgewater**
## **Angus Lees**
Angus has a strong commercial background and qualified to MBA standard. Cabinet Member at Dudley MBC holding the portfolio for the West Midlands Combined Authority. Member of the WMCA Overview & Scrutiny Committee, Housing & Land Board, Strategic Economic Development Board & Transport Development Committee. Previously worked within large corporations, and subsequently ran his own company for 11 years.
_Vice Chair 2016 - 2018, Chair 2018 - 2020_
Retired Consultant Cardiologist/Hon. Senior Lecturer; first Clinical Director of Black Country Cardiovascular Network 2003-2008; Trustee British Heart Foundation 2006-2014; Medical Director of Action Heart Prevention and CR Programme 1988-2020; ad hoc adviser to CQC, PHSO to March 2020. Chaired Clinical Standards Committee at Mary Stevens Hospice 2016 to date.
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## **Barbara Coles**
Barbara is a retired teacher having worked for over 40 years in Birmingham and Sandwell schools. Barbara had links with several hospices in past years and seeing the wonderful work they do, was keen to help in some way. Member of the Clinical Standards Committee.
## **Andrew Bagnall**
_resigned 1 November 2022_
## **Chair of the Lottery Board:**
## **Arthur Baker**
Arthur was a senior Finance Director for an international construction company, followed by many years working for a leading London merchant bank. For the 10 years prior to retirement he was Chief Executive of a UK Casino company. Arthur is a Director of Lottery, and now Chairs the Lottery Board.
Andrew qualified from Guy’s Hospital, London as a Registered General Nurse in 1993 and has worked in hospices in both Oxford and Wolverhampton throughout his career. Alongside his extensive clinical knowledge and experience, Andrew has delivered palliative and end of life training across all settings and presently works as a Senior Lecturer at the University of Wolverhampton teaching undergraduate to doctoral level students. As a Trustee at Mary Stevens Hospice, Andrew is co-opted to the Clinical Standards Committee.
## **John Graham**
_co-opted 16 November 2022_
John is proud to be ethnically Scots - both his parents are from Fife and he is named after his grandfather, who was a coal miner there. However, he was born and brought up in Kent. Inspired by his police officer father, who at one time prosecuted in the Magistrates’ Court, he went on from grammar school to read law at Birmingham University. After graduating, he studied further at the College of Law in Guildford and qualified as a solicitor in 1981. After initial employment in West Bromwich, he moved to Tanfields in Dudley, a firm later taken over by Talbots Law where he remained until retirement in 2020. During his legal career he practised in various types of litigation and disputes, appearing regularly in local courts. He lives in West Bromwich where he is a past Churchwarden, current Treasurer and member of the bell ringing team at All Saints’ Church. His other interests include the performing arts, music, theatre, the Rotary Club of Dudley, and food and drink. He is a reasonable cook and a barely competent guitarist. As a carer for his disabled partner Christine, he is familiar with personal care needs and mobility equipment.
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**Charity Governance**
## **Constitution**
The Charity was formed as a company limited by guarantee on 22 November 1985 and is governed by its Memorandum and Articles of Association. The Charity was incorporated in England and Wales.
As a company limited by guarantee it has no allotted share capital. Members of the company have a contingent liability arising from the guarantee given by each member to contribute, if required or on winding up, an amount not exceeding £1.
## **Trustees**
Trustees are appointed by the Board of Trustees at a Board meeting, but their appointment only takes effect once ratified by the majority of Company Members voting at a General Meeting or by written resolution. Under the Articles, Trustees are appointed for an initial four-year term, and a Trustee who is willing to continue in office may serve up to a maximum of two terms of four years. After completion of their second four-year term, a Trustee may only be appointed for subsequent one-year terms where the Board decide it is in the best interests of the Company to do so.
The Chairman is elected by his or her fellow Trustees following a recruitment and selection process. The Chairman Peter Marsh was appointed with effect from 20th November 2020.
Potential new Trustees are identified from a variety of sources including external recruitment, personal recommendation by members or the current Trustees. Often, but not exclusively, potential Trustees will have previously been associated with the work of the Charity perhaps as a volunteer, involvement in a support organisation or in the activities of a subsidiary company.
Selection for appointment is based solely on the likelihood it is believed the individual is likely to make to the development and delivery of
the Charity’s objectives having regard to their commitment, experience and in some instances, specialist skills.
Prospective Trustees are required to submit an expression of interest and provide references. A formal interview process is undertaken by a panel of existing Trustees and the candidates have an opportunity to meet key staff. For successful candidates, the appointment is approved by the full Trustee Board. On appointment, there is a formal induction process to consolidate the information previously gained.
The Charity’s Trustees are also directors of the company for the purposes of company law. Trustee indemnity insurance is provided for the benefit of the Trustees.
## **Subsidiary Companies**
The Charity has two wholly owned subsidiary companies which operate for the purpose of raising funds and promoting public awareness of the Charity. They are:
• Mary Stevens Hospice Trading Co. Limited (registered company number 02648133) which operates 13 trading outlets.
• Mary Stevens Hospice Lottery Limited (registered company number 03885815), which operates regular lotteries.
Each subsidiary company has its own separate Board that meets quarterly and is focused on that Companies activities, compliance, and performance. Each Company gift aids any profits made to the Charity.
## **Corporate Governance and Internal Control**
The Charity is governed by the Board of Trustees which is responsible for setting the strategic direction of the organisation, establishing policy, and agreeing the annual financial budget, business plan and monitoring progress against the budget. The Board meets regularly throughout
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the year. Overall responsibility for the day-today management of the organisation is delegated by the Board to the Chief Executive. The Chief Executive reports to the Chairman of the Board and together with the Director of Fundraising, Director of Finance and Director of Trading, attend all Board meetings.
## **Charity Governance**
Responsibility for the governance structure of the organisation is split between several committees and the Senior Leadership Team and overseen by the Governance Committee who meet quarterly. The make-up and responsibilities of these committees are described below. Trustees are encouraged to attend meetings of any of these committees and working groups where appropriate to their roles and interests. The Charity follows the Charity Governance Code.
## **Senior Leadership Team**
The Hospice Senior Leadership Team meets at least twice a month and comprises the Chief Executive, Director of Finance, and the Director of Fundraising & Trading Director. The meeting is chaired by the Chief Executive. The Senior Leadership Team is responsible for strategic leadership, Organisational development, external relationships, environment, change leadership and organisational communication.
• Scrutinise areas of risk and/or development and agree priorities and monitoring mechanisms.
• Utilise monitoring systems to evaluate progress at regular agreed intervals and recommend actions to mitigate risk as appropriate.
• Receive assurance that all systems and processes are integrated across all functions where appropriate e.g., incident reporting and complaints management.
• Receive assurance that all practice is evidence based and agree a programme of audit including falls, pressure damage, learning from deaths, nutrition standards and New Early Warning Signs.
• Promote safety and excellence in patient and family care.
• Monitor operational performance of clinical areas ensuring good utilisation of resources and response to any trends.
• Monitor progress with the clinical services strategy and assure the Board of Trustees.
• Have overview responsibility for compliance with the Care Quality Commission.
• Monitor the effectiveness of clinical practice.
• Ensure there are effective processes in place to manage infection risk.
## **Clinical Standards Committee**
The Clinical Standards Committee meets quarterly and is a standing Committee of the Trustee Board. The Committee is responsible for monitoring and assuring the clinical quality of services and that standards defined by external regulators are met. The Clinical Standards Committee comprises Dr. J. Flint Bridgewater (Chairman and Trustee), Dr Julian Hobbs (Trustee), John Graham (Trustee), Barbara Coles (Trustee), Claire Towns (Chief Executive). Other specialist members of staff are invited to attend for specific agenda items.
The specific duties of the Committee are to: • Maintain a strong awareness of the latest legislation and practices affecting or relating to our services and provide assurance to the Board of Trustees.
• Maintain a log of regulatory and commissioning obligations and requirements and report to the Board of Trustees.
• Ensure there are processes in place to effectively safeguard children and adults.
• Monitor the external environment and ensure Mary Stevens Hospice is responding appropriately to changes in commissioning, palliative care policy etc.
• Escalate issues to the Board of Trustees as appropriate.
## **Remuneration Committee**
This committee is responsible for ensuring the remuneration arrangements support the strategic aims of the organisation. The committee comprises Peter Marsh (Chairman and Trustee), John Turner (Trustee) plus an additional Trustee Dr Ellen Jane Flint meeting quarterly and as required. Claire Towns (Chief Executive) and Simon Henwood (Director of Finance) attend to provide a briefing and give evidence.
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The main responsibilities of the Committee are to:
• Formulate and monitor the organisation’s remuneration policy.
• Review the organisation’s salary banding process and related remuneration and reward packages against agreed independent market benchmarking tools and ensure the Hospice’s salary and reward packages are equitable, fair and remain competitive.
• Approve the annual cost of living salary increase for all staff considering rates of inflation and known NHS, charity sector and commercial benchmarking in the given year.
• Approve any non-consolidated pay awards (bonus) as recommended by the Chief Executive which relates to the Mary Stevens Hospice policy in this matter.
• Determine the remuneration and reward package of the Chief Executive and other Directors who are considered to have senior level responsibility for the leadership and management of Mary Stevens Hospice.
• Approve pension arrangements and ensure contractual terms on termination are fair to the individual and to Mary Stevens Hospice, that poor performance is not rewarded and, where possible, potential losses are mitigated.
• To determine and approve succession planning and talent management for the CEO and leadership team
## **Finance & Resources Committee**
The committee is responsible for:
The committee comprises John Turner (Treasurer and Trustee), Brian Blakemore (Trustee & Trading Chair), Peter Marsh (Hospice Chairman), David Martin (Trustee), Spencer Hodgson (Trustee), Cllr. Steve Clark (Trustee) Claire Towns {Chief Executive), Simon Henwood (Director of Finance) The committee meets up to six times a year and on other occasions as required to deal with specific matters raised by the Board of Trustees.
The specific duties of the Committee are to:
• Ensure the financial viability of Mary Stevens Hospice, provide stewardship of the charitable assets and oversee the annual external audit.
• Providing assurance to the Board of Trustees that all financial and income generation structures, processes, and controls are fully compliant with regulators and commissioners, are effective and efficient and are of the high standards expected of Mary Stevens Hospice.
• To develop, approve and evaluate progress against the Income Generation strategy and recommend actions to mitigate risk.
• To identify areas of risk and/ or development opportunity, approving investment and agreeing priorities.
• To support and review KPls ensuring appropriate monitoring mechanisms are in place which are specific to Income Generation.
• To review the financial position and income generation performance of Mary Stevens Hospice ensuring budget and achievement is realistic and ·proportionate to investment.
• To recommend the Reserves policy to the Board of Trustees and review the use of reserves.
• To recommend approval of the annual financial plan.
• Review the rolling forecast to ensure projections are reasonable and are aligned with the Trustees reserves policy initially approving any exceptions and escalating to the Board of Trustees for final approval.
• To set the accounting policies for Mary Stevens Hospice.
• To approve all banking arrangements and reviewing performance.
• To appoint external auditors and financial advisors and reviewing performance and ensuring adherence to Mary Stevens Hospice constitution ensuring that auditors and investment advisors are reviewed and re-tendered according to guidelines.
• To liaise with the external auditors before, during and after the annual statutory audit, ensuring all key issues identified are satisfactorily resolved.
• To review internal audit reports prepared by the finance manager, ensuring all key issues identified are satisfactorily resolved.
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• To monitor the performance of the Hospice’s investment managers and advising them of funding requirements both in terms of new investments and the timing of potential drawdowns.
• To ensure policies are reviewed annually or in line with designated review periods.
• To escalate issues to the Board of Trustees as appropriate.
## **Fundraising Governance Committee**
The committee comprises Peter Marsh (Chairman and Trustee), David Martin (Trustee), David Martin (Trustee), Spencer Hodgson (Trustee), Cllr. Steve Waltho (Trustee) Claire Towns {Chief Executive).
The committee meets quarterly to deal with the progress of Fundraising development and delivery for the Hospice. The specific duties of the Committee are to:
• To oversee Fundraising activities, evaluate progress against the Fundraising strategy.
• To develop, approve and evaluate progress against specific Fundraising activities and plans.
• To review the financial position and income generation performance of Fundraising.
• Review the rolling forecast to ensure projections are reasonable and are aligned with the Hospice expectations initially approving any exceptions and escalating to the Board of Trustees for final approval.
• To ensure compliance with code of fundraising practice and other relevant Fundraising Standards Board recommendations.
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**Summary of Main Activities**
At Mary Stevens Hospice we believe that people with progressive, incurable, life-shortening illnesses should be helped to live as fulfilling a life as possible until achieving a natural, peaceful and dignified death free from pain or anxiety and surrounded by those whom they love.
## **Clinical**
• Provide care, compassion and kindness for patients, families and carers from a Consultant led, multi-disciplinary team.
• Aspire to be a centre of excellence in the provision of specialist palliative and end of life care which is safe, caring, effective and responsive to people’s needs.
• Provide training and education to improve care at various stages along the patient journey.
• Sustain a diverse, adaptable, well-motivated team of volunteers to support service delivery.
## **Fundraising**
• Mary Stevens Hospice aims to minimise the cost of fundraising activities.
• To ensure we are making the best use of generous donations we benchmark different fundraising channels and techniques to ensure that they are competitive.
• We work hard to ensure that we can report back to our donors on the results and impacts that their giving achieves.
## **Income Generation**
## **Principal Risks and Uncertainties**
The Trustees are acutely aware of the need to identify and assess the principal risks and uncertainties faced by the Hospice. A risk register is maintained and is reviewed at all meetings of Trustees. The register extends to 64 separate risks and assesses both the likelihood of a risk occurring and it’s consequence, enabling the relative significance to be determined.
The risks cover clinical, financial and regulatory issues. The principal financial risks and the measures being adopted to minimise them are detailed elsewhere in this report. Risks are also minimised by appropriate training both in clinical areas but also regulatory areas. The impact of the Covid 19 pandemic has necessitated significant operational changes across all departments.
The Senior Leadership Team with Trustees support and scrutiny, are focused on the continued risks to the business as the trends of the current economic climate create future uncertainties.
## **Our Fundraising Standards**
We abide by the Fundraising Code of Practice which covers all aspects of fundraising and good practice. We work hard to protect our supporters’ data, as well as evolving our systems to ensure that our supporters can choose how they would like to be contacted and with what types of communication. We have acted to ensure we are fully compliant with The Data Protection Act 2018.
- Develop a sustainable income generation model.
- Raise income ethically and in a responsible way.
- Develop an improved range of activities for the Trading subsidiary.
- Develop local fundraising support.
- Develop and implement a revised legacy strategy that encourages people to leave us a gift in their will.
- Recruit corporate supporters.
- Develop strong fundraising links with the local community.
- •Promote membership of The Mary Stevens Hospice Lottery.
The Hospice recognises its duty of care to members of the public and, in particular, to vulnerable persons. The Trustees have approved a Safeguarding Policy and all members of the Fundraising Department and Trustees are Disclosure and Barring Service registered.
Risk assessments are carried out for all the fundraising events.
The fundraising department received no formal complaints during the year.
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**Strategic Report**
## **Successes and Objectives**
In 2023, all Hospice staff and volunteers are being consulted in developing the new 3-year strategy. It is important to the Senior Leadership Team that the strategy is owned by everyone.
As a result of this piece of work, the plans for 2022-2023 do not represent a drastic deviation from the current plans.
As a business we continued to grow activities that hold strategic importance, these include:
• To invest in and support our workforce
• To increase our focus on diversity and inclusion, across both paid employees and volunteers
• To focus on areas of income generation including legacy income where there is growth potential
• To further increase access to both adults and children’s bereavement services across the local population
• To be recognised as a local provider of specialist palliative care services that is operating a consultant led model
The broad themes for the new 3-year strategy currently under staff consultation are
posts have allowed expansion of services. The physiotherapy post has developed more focused care for cohorts of patients attending the FAB (Fatigue And Breathlessness) group; whilst the therapy post has addressed the growing demand for therapies particularly for outpatients or persons accessing therapies as part of their bereavement care.
The In Patient unit team was restructured, leading to improved leadership within the team.
There has been significant investment in staff training with all Band 6 nurses being supported to complete enhanced clinical skills training.
In partnership with the local acute NHS Trust and funded by NHS Charities Together 2023 saw the publication of No Barriers Here©, palliative care research study and service improvement project which focused on advance care planning with minoritised ethnic communities.
Bereavement services have grown and continue to do so. The major success is that the services are no longer offered solely to people known to the Hospice. There are bereavement information points in the Hospice shops and in public places such as banks, libraries and other community settings.
The Hospice pharmacist was up-skilled and qualified as an associate principal research investigator. The hospice has been recruited to the CHELsea study.
1. Promote environmental sustainability
2. Care for patients and carers expanding our reach
The Trading company underwent further restructuring to improve efficiency. They have also invested in new till software within the shops which should result in more robust Gift Aid claims.
3. Develop financial and operational sustainability
## **Successes and Achievements**
The following pages of the report highlight the delivery of key projects during 2022-2023. Each has contributed towards the delivery of the Hospice’s strategic aims.
A 2 year grant funding programme has seen the Day Services Unit expand both its physiotherapy support and complementary therapy lead. Both
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**In Patient Unit**
**April 2023 - March 2023**
## **Post COVID 19**
Caring for patients and seeking to ensure they remained safe during the COVID 19 pandemic whilst also trying to maintain a sense of normality with visitors spending time at the hospice has been difficult, but we managed this successfully.
Maintaining adequate and safe staffing numbers when COVID 19 levels fluctuated was only possible because of the commitment and dedication of the IPU team and members of our nursing bank who responded to the call and worked additional shifts.
We are learning to live with the unpredictable influence of COVID 19 and seeking to ensure we have a robust system in place to balance the demand upon our limited number of beds and the availability of staff. Our strategy has been to ensure our nursing establishment is optimised as we have advertised vacancies and increased the number of bank nurses and health care assistants we can call upon.
Visiting times are affirmed as 11am until 8pm with no restriction on the number of individuals now visiting patients, although visitors are encouraged to liaise with others to ensure patients are not too tired or the number of visitors isn’t concentrated at particular times. Open visiting is available for those patients who are deteriorating or nearing the end of life, with loved ones welcome to stay overnight should the need arise.
## **New Ward Manager**
Andrew Bagnall joined the team on 3rd January 2023 having served as a Trustee for 12 months prior to his appointment. Andrew has brought a wealth of clinical and educational experience having worked in palliative and end of life care for over 30 years. Andrew has identified a number of projects which includes the ongoing development of IPU staff, including the revisiting of job descriptions to ensure staff are working to and achieving their potential, and an education and development programme to ensure both registered nurses and health care assistants have the knowledge and skills to care for those requiring palliative and end of life care. A working group continues to meet in readiness
for introducing new uniforms to IPU and the Nutritional Working Group is developing new ideas to meet the dietary requirements of patients admitted to IPU irrespective of cultural or ethnic background or dietary preferences.
## **Air Conditioning on IPU**
Air conditioning was installed into each of the 10 IPU rooms which has been of great value during periods of hot weather and for the purposes of keeping the deceased in an appropriate environment. The cost of the installation was approximately £10,000.
## **New Patient Recliner Chairs**
Five new chairs were ordered some months ago but delayed due to a relocation of the Company. However, these have now arrived and are a welcome asset to the rooms without a comfortable recliner chair. The cost of these 5 chairs was £8,550.
## **IPU Refurbishment**
Refurbishment is planned to start during the next financial year. This will involve the addition of 3 en-suites into existing bedrooms, alongside the development of one larger bedroom; an overnight flat for relatives/visitors; a larger office for ward staff; enhanced changing rooms; and a modified patient/visitor lounge.
## **Education & Training Programme/Staff Development**
A comprehensive programme of education and training, including updating of clinical skills has been prepared which IPU staff can access during the refurbishment which means we’ll be managing the care of patients alongside the closing and reopening of patient’s rooms. This programme will mean that all staff can identify their own learning needs and take advantage of the training on offer.
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Admissions
Deaths
Referrals
CARE I COMPASSION I KINDNESS
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## **Medicines Management**
## **April 2022 - March 2023**
Medicines management at the Hospice has changed significantly this year. We have further embedded an Electronic Prescribing and Medicines Administration (EPMA) system; which is reducing risk and ensuring that patients ‘Get it on Time, Every Time’. The service provider we are using continues to be most helpful in supporting with this venture. The whole team have seen the improvement this yields in terms of prescribing and reviewing prescribing and administration records also; something which we do frequently to ensure we are always following best practice and moving forward as the speciality of palliative medicine evolves.
We have also changed our medication supplier to the same service provider this year too, which helps to streamline the whole process from admission through to discharge and
beyond. It also fulfils our obligations to ensure the necessary licences are in place for us to source and administer the medications our patients so readily need.
These are exciting times from a pharmacists perspective, and they provide another valuable addition to ensuring that medicines are used safely, appropriately and with respect within our Hospice.
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## **Day Unit Activity**
## **April 2022 - March 2023**
During 2022/23 the Day Service Unit continued to operate between Monday to Friday, with various groups and clinics taking place each day. We worked closely with the community teams, attending weekly multi-disciplinary team meetings with Dudley Community Rehabilitation Services, Motor Neurone Disease (Queen Elizabeth Hospital and Dudley teams) and the Dudley Living with and Beyond Cancer support service. This collaborative working has enhanced professional relationships and improved access and care for patients.
## **Clinics**
On average 3 new patients per week accessed Day Service Unit for a clinical review, a service that takes place twice a week supported by the hospice medical team and delivered by the Day Service Unit nursing team. The clinics offer patients the opportunity to a holistic assessment, reviewing individual need supported by an Integrated Palliative Care Outcome Scale (IPOS) score. Following the initial assessment, people may be referred or introduced to additional Hospice groups and services such as complementary therapies, spiritual care, patient and family support, psychotherapy, social support, physiotherapy, legacy work, or the In Patient Unit. Moreover, clinics offer the time and space for advance care planning and ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) discussions and documentation.
A medical review clinic commenced in March 2023, supported by the hospice specialist palliative care pharmacist prescriber, with an average of 6 patients per week accessing the service for symptom management and continuation of advance care planning and ReSPECT decision making conversations.
We provided the following clinics, support groups and activities either fortnightly or monthly at the time under report. Some of these were delivered by specialist condition nurses and allied health professionals such as a Motor Neurone clinical nurse specialist, a Parkinsons specialist nurse and a palliative physiotherapist.
- Neuro Well being
- Parkinson’s clinic
- Motor Neurone and Dudley Rehabilitation Team
- Motor Neurone Society Support
- Peer support groups
- Singing is FAB
- Mens and ladies groups
- Monday Mindfulness
The Motor Neurone Society continued to hold a monthly support group for around 8 people who have or are living with someone with Motor Neurone Disease, assisted by members of the Day Service Unit team. Not all attendees were previously known to the Hospice, therefore, attending this group afforded them the opportunity to access support and learn about the care and support the Hospice provides.
We are in the process of extending clinic sessions at the Hospice, working in collaboration with other healthcare disciplines from other areas, with a specific focus on non cancer diagnoses. This will enable current patients to access specialised clinics and introduce new patients to the Hospice, extending our reach and supporting more people who require our care.
## **Courses and therapeutic activities**
We have delivered 7 cycles of Fatigue Anxiety and Breathing (FAB) courses since March 2022, supporting around 60 new patients. Alongside FAB we delivered an additional 7 Neuro Wellbeing courses, also supporting 60 new patients. These courses, along with other activities presented in the table below, continued as rolling programmes with patients referred to the hospice by external healthcare professionals and organisations.
A monthly peer support session offers a less structured group. In addition there is a Singing is FAB and a mens and ladies group that involves therapeutic activities such as woodwork, horticulture, sewing etc. Patients either attended sessions between 10am and 3pm or as a drop in session with access to complementary therapies, physiotherapy, social support, advance care planning or carer support. Up to 15 patients attend these sessions.
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## **Mindfulness**
## **Physiotherapy**
From July 2022, mindfulness was available for patients and their loved ones to access over an 8 week course, with 6 people supported per programme. Where people felt unable to participate in small groups supplementary individual sessions were offered. A monthly mindfulness session available to group beneficiaries was well attended with around 15 people accessing each session.
## **Art and Music Therapy**
Between October 2022 and February 2023, we were supported by Beat It Percussion CIC, who promote mental health and wellbeing through rhythm and sound and facilitated a weekly drumming group. Following positive patient evaluation and support from the Hospice Trusts and Foundation Manager, we were successful in a funding application for regular music therapy Day Service Unit.
We continued to receive funding for one-to-one art psychotherapy and the sessional therapist supported up to 6 patients, carers and pre and post bereaved people in a weekly clinic in Day Service Unit and In-Patient Unit.
The physiotherapy service, supplied by Stourbridge Physio, was increased with the addition of a physiotherapy assistant role. This enabled the registered physiotherapist to assess, plan and evaluate treatments more effectively. The role delivered FAB sessions and support patients on the In Patient Unit and in their own homes with mobility or equipment issues, working collaboratively with the community teams. The role supported a new 6 week group exercise programme, individually tailored for a maximum of 8 people, and facilitated by the physiotherapy assistant for patients to access who attend FAB, wellbeing groups or via referral from other Hospice services. Similarly, a one to one balance assessment programme over 3-4 sessions with a member of the physiotherapy team was developed for patients to be referred to if experiencing balance and mobility issues.
## **Telephone and additional support**
We supported an average of 20 patients and carers at any one time who, due to a deterioration in their health, were not well enough to attend Day Service Unit in person. The telephone support offers practical and clinical information and guidance whilst maintaining communication with patients and carers.
## **Complementary Therapy Coordinator**
Grant funding enabled the Day Service Unit team to expand with the development of a complementary therapy coordinator role. The FTE post has been funded for two years and is shared between two staff nurses who assess, plan, and evaluate treatment plans for new and existing patients in addition to supporting other healthcare staff qualified in complementary therapies.
The role has ensured that we can continue to develop the complementary therapy service and support more people.
Further support for patients during 2022/23 included the use of our bathing facilities (a spa bath or shower) for people who are unable to access this at home with, assistance from a family member or friend, carer, or Hospice staff. This has again enabled people to be introduced to the Hospice who previously had not accessed our support.
## **Education and development**
We supported two occupational therapy students from Worcester University with a work placement on Day Service Unit. This was a positive experience for all involved and we have agreed to continue working with the University to offer regular student placements.
## **Monday**
## **Tuesday**
## **Wednesday**
## **Thursday**
## **Friday**
Beat It Percussion
Neuro Well-being
Fatigue, Anxiety and Breathing (FAB) Mindfulness
Clinic review Clinic review Art Group exercise psychotherapy
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## **Trusts that supported us during 2022/23**
## Hospice UK
The National Lottery - Reaching Communities The Albert Gubay Foundation Lasletts Charities Tipton and Coseley Building Society Charitable Foundation The Albert Hunt Trust Pedmore Sporting Trust One Stop / Groundworks Baron Davenports Charity Arnold Clarke Community Fund The National Lottery - Awards For All Benefact - Movement For Good Awards Wilmcote Charitrust The Grimmitt Trust The Roger & Douglas Turner Charitable Trust Groundwork UK - Tesco Community Grants The Hilary Awdry Charitable Trust The Grace Trust Michael and Anna Wix Charitable Trust The Souter Charitable Trust E H Smith Charitable Trust Rest-Harrow Trust The Dumbreck Charity The Screwfix Foundation Hospice Aid Hopkins Sayer Sainsbury’s - Helping Everyone Eat Better Community Grant The DMF Ellis Charitable Trust The Ken Wrigley MemorialTrust The M K Rose Charitable Trust DMBC / Dudley CVS - Reducing Health Inequalities The Edward and Dorothy Cadbury Trust The Muntz Trust The Orange Tree Trust The Anthony and Gwendoline Wylde Memorial Charity The Brian Shaw Memorial Trust The Birmingham District Nursing Charitable Trust The Eveson Trust The W.E.D Charitable Trust G J W Turner Trust The Stella Symons Charity Albright Grimley Charity Edgar E Lawley Foundation Buchanan Programme & Keith Halewood
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## **Equity, Diversity and Inclusion**
We continued to innovate and develop our equity-orientated and inclusion work at a local and national level during 2022-23. We have made significant progress in this field, including research, projects, education and working collaboratively with system partners and in co-production with underserved people and communities. However, there is more for us to do to continue to break down barriers and disrupt the inequity that we know many people and communities experience who need to access our care and support.
A film about No Barriers Here with people excluded by identity, culture, ethnicity and race, funded by the National Lottery, was launched in Bruges at the Public Health Palliative Care International Conference 2022 to a global audience.
Oral presentations were delivered at:
- Hospice UK National Conference
- Public Health Palliative Care International
- Worcestershire Palliative Care Conference
- Bradford Institute for Health Research
## **Education, research and sharing our learning**
We increased our national presence as a Hospice who empowers and inspires others to address inequity, doing it with authenticity, creativity, and innovation at its core. This included sharing our learning with others at conferences and the delivery of educational programmes, webinars, face to face education, the review of an e-ELCA module and becoming a visiting lecturer at Lisbon University teaching about palliative care and learning disabilities in the UK.
- Hospice UK Echo and strategic clinical network
In addition, there was also an invitation to deliver a plenary session at Palliative Care Congress where abstracts were accepted for the European Association of Palliative Care Conference.
Our work was cited in The Oxford Textbook of Public Health Palliative Care. A book chapter was written for The Handbook of Palliative Care (Fourth Edition) is due to be published in November 2023. Blog posts were published by Hospice UK, ehospice and European Association of Palliative Care.
There has been significant engagement in the No Barriers Here© X (formerly known as Twitter) account and an Instagram account has also been opened. The development of a new funded website www.nobarriershere.org was a key strategic engagement development during the year under report and we were delighted to work with Concept 4 to develop this platform and launch it at Hospice UK National Conference in November 2022.
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Internal learning opportunities were provided for Hospice staff to access face to face education and increase their knowledge, awareness, and skills including:
- Domestic abuse in older adults training
- Learning Disability and Autism Awareness training
• Level 1 and Level 2 Makaton communication skills
## **No Barriers Here© Facilitator Training**
In March 2022, we successfully expanded the range of external education on offer and piloted No Barriers Here© Facilitator Training, a learning programme that is unique to Mary Stevens Hospice. The training has been delivered at Mary Stevens Hospice and bespoke packages delivered in Somerset, Weston-super-Mare, North London, South London, Suffolk and Portugal where we now have palliative medicine consultant using the model in an aged-care facility in the The Azores. The training was highlighted in a case study about No Barriers Here© published by NHS England and the Inspire Report for Integrated Care Boards. The training is proving popular for bespoke delivery and is being commissioned across several Integrated Care Systems. In addition, a community of practice has been developed for trained facilitators, external funding received for administrative support and the training team is in the process of being expanded.
_**“What a fantastic inspirational training session you delivered. Thank you both very much for the entire day. Your style of delivery, content and the resources were superb, and I am still buzzing about the day!”**_
_**“I didn’t know what to expect but it was amazing. The pace of the day was excellent, the knowledge shared, information and resources provided and the experiential design. EVERYONE should attend this training that works in palliative care!”**_
## **Research**
• No Barriers Here for people excluded by identity, culture, ethnicity and race was a twoyear palliative care research study and service improvement project focused on advance care planning with minoritised ethnic communities.
• _‘It’s more than rainbows in receptions’_ is a Marie Curie Impact Research Fund study working in co-production with LGBTQ+ people and communities led by Mary Stevens Hospice.
• The Victoria & Stuart Project is funded by the National Institute of Health Research (NIHR) with Mary Stevens Hospice co-applicants of the study led by Kingston University and St George’s, University of London.
_**“The first thing that struck me about No Barriers Here was the name - it unapologetically shines the light on the issue for those of us from minoritised groups. It is not us that are hard to reach, it is the barriers that need dismantling. It makes me feel safe. The second thing is the people who have created this space before it was ‘flavour of the month’. There is now a drive for ‘community engagement’ with little pause to think about who the best people may be to engage. Not everyone can do this work, it depends on trust.”**_
## **Funding and Income**
The charitable activity funding for the development and delivery of equity, diversity and inclusion projects and research during this term amounted to £128,000 to Mary Stevens Hospice from external grant funders and research institutes. The development and delivery of our education portfolio in this specific area generated an additional income of £40,000.
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## **Celebrating success**
It is also necessary to concentrate on applying an organisational strategic development lens on equity, diversity and inclusion; to recognise and address systematic inequity and develop an inclusive culture at Mary Stevens Hospice and its environment for staff and volunteers including the review and development of robust equity, diversity and inclusion governance, policy and hospice operations.
In May 2022, Mary Stevens Hospice celebrated being shortlisted and reaching the final 3 for the NHS Quality Improvement Awards for No Barriers Here in the ‘Improving through co-production’ category. The work was also shortlisted for the Great British Care Awards.
This is a sector which is facing the significant challenges of including financial burden in the current economic and social climate and staff recruitment and retention issues. We will look forward to how we enhance and improve what we do in our community and internally, with clear purpose and ambition to ensure future development, impact, and sustainability of this work.
In March 2023 we were delighted to win the 3rd Sector Care Awards ‘Development and Innovation Award’ for the No Barriers Here model and education programme.
## **Priorities for 2023-24**
The progress of Mary Stevens Hospice community outreach, equity, diversity and inclusion work over recent years has been an essential foundation to addressing and responding to inequity and disadvantage of marginalised people and communities. We will continue to prioritise a community focused approach through collaboration and co-production, listening to previously unheard voices to help understand their experiences and barriers to care, improve accessibility and widen access to palliative care.
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IION I'KiNDNEsI
## **Bereavement Service**
## **April 2022 to March 2023**
## **Overview**
This year, the Bereavement Service has provided more than 350 hours of support to over 150 people who have accessed us for help and guidance on managing their grief.
## **Services**
We prioritised ensuring our bereavement care was more accessible for the wider community, creating a direct bereavement service telephone line and enabling self referral for Supportive Listening.
## **Volunteers**
Our service would not exist without volunteers, and we are grateful to those who have supported us in the past and present by offering their time, expertise and kindness to those in need. Face-toface training undertaken by volunteers this year included:
- Makaton
Kerrie Jones was instrumental in developing the Community Companions project before its transfer to the Volunteer Coordinator and Karen Pardoe transferred legacy work to Day Service Unit and In Patient Unit, training clinical staff in the methods used in creative legacies. We also began internal conversations around gaining skills to incorporate a co-productive approach to future projects.
- No Barriers Here Awareness
- Learning Disability and Autism Awareness
## **Supportive Listening**
- Supportive Listening
- Refresher Supportive Listening
## _**“The role gives me a great sense of purpose and satisfaction.”**_
## **Staff**
In the first quarter, we bade farewell to Karen Pardoe who moved to Day Service and In Patient Unit after developing bereavement and legacy support and welcomed Bereavement Support Coordinator, Deb Clarke, to work alongside Kerrie Jones. In addition to mandatory training, the Bereavement Team participated individually in various courses and learning opportunities including:
- Level 2 Counselling Skills
- Support Your Volunteers
- Domestic Abuse in Older Adults
- Learning Disability and Autism Awareness
- Work Life Balance
- Boundaries in 24/7 Culture
- Volunteers and the Law
- Child Bereavement in Schools
- Suicide Awareness
The Supportive Listening service offers free face to face or telephone bereavement support individually. It provides the opportunity to speak with a trained volunteer over at least 8 sessions. This year, volunteers and staff have delivered over 190 hours of Supportive Listening to people who needed help on their bereavement journey.
_**“The team are professional, friendly and compassionate. I am so grateful... the support I have received has been invaluable.”**_
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In January, 7 new prospective volunteers attended 4 days of Supportive Listening training and long-standing volunteers were offered a 1 day refresher course. In addition, group supervision continued to be facilitated once a month for supportive listeners and included short learning modules of peer and staff learning on:
- Best Practice Note Taking
- Social Media and Grief
- Grieving at Christmas
- Mental Health Conditions
- Suicide Awareness
- Neuroscience of the Grieving Brain
- Alcoholism and Grief
_**“The one thing I’ve learnt...is to never lose the compassion and love that makes it such a wonderful thing to be a bereavement listening support volunteer.”**_
## **Bereavement Hub**
The Bereavement Hub is a monthly drop in group that offers people in the community the opportunity to meet others who have experienced loss and grief. Alongside peer support, it includes sessions on understanding aspects of bereavement, accessing support and signposting, and a chance to engage in creative and wellbeing activities.
This year we supported 32 people in our hub who were supported by trained voluntary facilitators during the monthly sessions. Facilitators attended preparatory and reflective meetings with a Bereavement Coordinator prior to and following each hub event.
_**“Just being able to talk to people who understand my pain has been such a big comfort. Being in an environment where I do not feel the odd one out has been so helpful.”**_
## **Telephone Support**
Our telephone information line offers timely, practical, and compassionate information and signposting related to hospice support. It is available 7 days a week between 8am – 4pm.
Over the year, we received over 70 support request calls from members of the public asking for support or questions related to hospice, palliative and end of life care including bereavement support and signposting.
## **Bereavement Information Point**
We adapted to different ways of engaging with members of the public and have a Bereavement Information Point available within the Stourbridge Mary Stevens Hospice shop where people can access local and national bereavement support and information.
## **Children and Young People**
Using both conversation and creative engagement, we continued to support children and young people who require bereavement support within the hospice. Bereavement Coordinator Deb Clarke is now developing one to one creative bereavement support to offer children in addition to group creative activities.
In November, we hosted the Bereavement Matters in Dudley Children and Young People subgroup. Meeting at the Hospice the group have inputted into the latest draft guidance.
## **Counselling and Therapy**
Our internal and freelance therapists and counsellors provided 116 hours of support to bereaved members of the public and staff who required mental health support during 2022/23.
## **Community Engagement and Events**
## **Children’s Grief Awareness Week**
During Children’s Grief Awareness Week, the hospice ran an online support and awareness
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campaign via the Hospice Facebook page and Bereavement Service X (formally known as Twitter) platform.
## **Say Hello Benches**
In June we participated in Loneliness Awareness Week 2022 and facilitated a ‘Say Hello’ bench in Stourbridge Town Centre for 3 days of the national campaign. The benches were decorated and were available for people in the community to stop by and talk about their experiences of loss and grief with our bereavement volunteers.
## **Grief Awareness Week, Tree of Light and #IRemember Week**
In the period between October and December we invited members of the public, family members and friends of people connected with the hospice to remember their loved ones and receive bereavement support as part of national and hospice events.
## **Christmas Tree Festival**
A Bereavement Service Christmas Tree was displayed in St Peter’s Church Christmas Tree Festival from the 1st to the 4th of December 2022 and was awarded second place by judges! The decorations included information on bereavement and the hospice, enabling the opportunity to share information about the services we provide, including how we can support bereaved people. Visitors to the festival were invited to write messages to family and friends who had died and hang their messages on the tree.
## **Connecting with the Sector**
## **Hospice UK Conference**
In November, members of the hospice team attended the Hospice UK National Conference 2022 in Scotland.
Kerrie Jones said:
_**“The conference was a great experience, and it was a wonderful opportunity to network with different hospices. I attended lectures highlighting research which has now enabled me to change my own practice and bring lots of new ideas into my role.”**_ **Learning From Others**
During March we visited Kemp Hospice to learn about their extensive bereavement service for children and young people. The visit enabled us to learn from them and share information about the services we offer. Taking the time to engage with Kemp Hospice has been helpful and we hope to continue with future conversations. We are also engaging with Compton Care and have arranged to visit during April 2023.
## **Online Events**
We attended the online launch of the UK Commission on Bereavement and have a copy of the report in our reference library to refer to when developing new projects and services. We also attended the Childhood Bereavement: International Symposium on Rights and Support in bereavement and gained new learning and awareness on the issues involved.
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350 hours of bereavement support 190 hours Supportive listening 32 people accessed the Bereavement Hub 70
support calls via Telephone Support Line 116 hours of bereavement therapy and counselling
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**Key achievements from education perspective**
## **March 2022 to April 2023**
## **Sage & Thyme**
The education team have delivered 4 workshops to 75 staff as part of a Health Education England contract.
- Non-malignancy at end of life and palliative care emergencies
- Communication and advance care planning
- Palliative and end of life care “It’s not rocket science.”
- Loss grief and bereavement
“Notice distress, listen carefully and respond helpfully” We have received very positive written feedback from delegates.
## **ReSPECT**
Supporting the ongoing role out and embedding of the ReSPECT process across the Dudley health economy. The education team delivered 7 sessions to 259 staff members across Dudley Health economy including Acute Trust, Community Services, General Practitioners, Nursing/ Residential Care Homes. The education team also trained 2 band 7 nurse specialists who were commissioned to go into Dudley care homes and complete the ReSPECT process with residents and their families and to assist care home teams to then carry this important process forward.
## **Mandatory and New Staff Induction Training (Ongoing)**
The education team have provided a face-toface induction training program to welcome 27 new staff to the organization covering essential topics:- Introduction to Mary Stevens Hospice and Palliative Care, Fire Training, Moving and Handling, Health and Safety, Adult Safeguarding, Equality and Diversity, Communication, Infection Control, Information Governance, Basic Life Support and the Care Quality Commission(CQC). Ensuring all aspects of mandatory training within the hospice are addressed, both face to face and online. Monitoring compliance and feeding back to individuals and line managers as appropriate.
## **Palliative Care Champions Training**
The education team provides bespoke Palliative and End of Life Champions training days for Hospice staff
- Symptom control at end of life
14 staff members have completed 2 or more of these study days with an ongoing rolling program to allow staff that were working on shift, some flexibility to attend other sessions.
## **Nursing and Management Competencies**
The education team provide ongoing support for staff to complete role specific care and management competencies. These are important to provide documentary evidence that our organisation is developing the nursing team and ensuring high standards of care are being provided for the people we look after. These documents offer proof to the Care Quality Commission (CQC) that we are Safe, Effective, Caring, Responsive and well lead. The education team support staff are to work through these documents in their own timeframe. Education staff have rostered hours in the work week to work directly with staff.
In addition 8 staff members from the In Patient Unit have attended a bespoke clinical skills study day:- Cannulation, Venepuncture, Non- Invasive Positive Pressure Ventilation(NIPPV), Percutaneous Endoscopic Gastrostomy(PEG), Male and Female Catheterisation, Tracheostomy Care.
## **Revalidation**
As a professional requirement from the Nursing and Midwifery Council (NMC), Every registered nurse must provide proof of revalidation. The education team provide support for staff to complete these requirements and are closely involved with two of the specific elementsReflective discussion of five pieces of reflection on their practice, linking these closely to The Code, and Confirmation that they have achieved all the mandated requirements.
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## **First Aid at Work**
Training has been completed for several members of the wider hospice workforce and has included several staff from each of our retail outlets. 10 members of the retail management team have successfully completed emergency first aid and a further 17 team members have been successfully trained.
## **Collaborative Working**
The education department has hosted several events for Hereford and Worcester Palliative Care Specialist Registrars, introducing them to Mary Stevens Hospice and the team.
The education team also provided a bespoke End of Life Care study day for 14 paramedics who were developing a new role in Dudley General Practices.
## **Carers Support**
Following discussions at Esther Olivier’s carers group, several bespoke education sessions were developed for carers- People Handling, Emergency First Aid and Care at End of Life. Verbal feedback from these on the day was very positive:
## _**“I have learned more today than 2 years of Occupational and physiotherapy input”**_
_**“I wish I had known this at the beginning of their illness”**_
## **Student Support**
The education team have been providing placements and supporting a number of healthcare students:
- Nursing students from Birmingham City University and Wolverhampton University
• 4th year medical students from Birmingham University and additionally from Aston medical School since autumn 22
- Social worker students
- Student Occupational Therapists
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**Social Work**
**April 2022 - March 2023**
## **Carers Group**
We support 157 carers at any one time at the hospice and the carers group is always well attended with a focus on education, relaxation, socialisation and building relationships to support each other. In addition to face to face support, carers can choose to support one another through a group What’s App platform, which is very successful. During June 2022, we recognised our carers throughout Carers Week, arranging events and activities concentrating on relaxation, mindfulness, and complementary therapy.
## **Community Focus**
Several exhibitions were held and supported in the community to raise awareness of Mary Stevens Hospice, these included:
- Dudley Market
- Stourbridge Football Club
- Stourbridge and Dudley Hospice shops
Turkey and Syria. We additionally support social workers who are working in these countries. The hospice social worker is a member of the Association for Palliative Care Social Work and a co-representative, arranging educational sessions for palliative care social workers in the Midlands every two months. We are currently supporting the Marie Curie campaign to support people living in poverty at the end of life.
## **Education and Student Mentorship**
The social worker is a qualified practice educator enabling the hospice to provide placements for social work students over 100 days. A recent success story involved a student who received a first class in a master’s degree in social work and received an award from Gloucester University for their practice placement at Mary Stevens Hospice. In December 2022, we hosted our first frontline social work student who worked with the team until April 2023.
- Dudley Sports and Social Club
- Halesowen Carers Hub
- Gloucester University
- Birmingham City University
We also represent Mary Stevens Hospice at various meetings and networking events.
## **Dudley Carers Alliance**
We regularly attend Dudley Carers Alliance meetings, taking place every two months and joined them to organise a borough-wide Festival of Light event to celebrate carers in the community. Patients in the hospice In Patient and Day Services Units contributed to the event, painting glass jars to exhibit throughout the borough, before gifting the decorations to carers.
## **British Association for Social Work (BASW)**
The BASW are an educational group that focuses on social work policy and procedures in disaster areas. We support other organisations in the community to send emergency kits to Ukraine,
The social worker is involved in various educational and research activities across several academic institutions:
- Social Justice Research Group (Gloucester University)
- Lecture at Wolverhampton University about being a hospice practice educator
• Co-presented an online social work conference with Siobhan Maclean, a well known author and national educator in social work.
## **Awards**
## **Dudley CVS Award**
Chris Wrigley won a Dudley Community Voluntary Service Award for his work with the social work department, including supporting students over the past four years.
## **Social Work Awards**
The Day Service Unit multi-disciplinary team was a finalist for a national Social Work Award 2022
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for Team of the Year for the work that they do within the hospice.
The social work team reached the finals for a second award for Digital Transformation in Social Work Award 2022. The nominated award was for a person centred, audio-visual video featuring carers and patients who attend Mary Stevens Hospice, speaking about their long-term conditions and experiences of accessing care and support from there.
## **British Association for Social Care Award**
In March 2023, the social worker was a finalist in the national Social Worker of the Year Awards award for practice educators in social work.
in the national Social Worker of the Year Awards award for practice educators in social work. 11 people rehoused 123 families supported respite care for 187 statutory assessments 17people 158 people supported to referrals 31access nursing home care 69 carers assessments statutory social care people were assisted in 52assessments 15 accessing financial support 64 home visits 11 mental capacity assessments funeral care for 38 external referrals 9 ongoing safeguarding referrals 7people
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## **Spiritual Care**
## **April 2022 - March 2023**
During 2022/23 alongside our spiritual care coordinator, 2 volunteer chaplains have continued to visit the In Patient Unit each week. They have given time, space and a listening ear to patients, visitors, and staff. When requested, they have also offered prayer at the time of visiting or later in their own time. Volunteer chaplains have given invaluable support, not only to the In Patient Unit but also to the spiritual care coordinator, providing over 150 hours of voluntary service throughout the year. An additional volunteer chaplain, who has extensive nursing and spiritual care experience was appointed in March 2023 to provide regular support and cover to the Spiritual Care team.
## **Day Service Unit**
Various aspects of spiritual care are offered and provided to the Day Service Unit including:
· An introductory session on spiritual care that is part of an eight week course for patients with neurological conditions or fatigue and breathing difficulties. The sessions delivered by the spiritual care coordinator continued to be well received and often led to further individual conversations, home visits and requests to conduct funeral services.
· In 2022, the physiotherapist and spiritual care coordinator introduced regular singing sessions to follow up the Fatigue, Anxiety and Breathing (FAB) courses. Singing is widely recognised as having several therapeutic benefits and following a pilot event ‘Singing is FAB’ is set to expand during 2023/24.
· Notice boards in the Day Service Unit peace room were updated and additional resources made available for patients to access including leaflets on spiritual care and prayer cards.
· Discussions are underway to introduce regular support sessions for people who want to explore aspects of spirituality in more depth.
## **In Patient Unit**
The spiritual care team endeavour to meet every patient, as well as members of their family, friends, and carers. They offer support as requested by the individual and make referrals as required.
## **Bereavement Support**
During the year under report, the spiritual care coordinator was invited to conduct six funeral services on behalf of the hospice. Wherever possible, funeral service booklets are uploaded to SharePoint for staff to view. A list of people cared for by the hospice and who have died is displayed in both Peace Rooms alongside an electronic candle which ‘burns’ 24/7. The list is updated every 1-2 weeks in addition to a Book of Remembrance which is regularly viewed by family members, friends, and loved ones.
## **Spiritual Care Education and Training**
The spiritual care coordinator has delivered training to new and returning volunteers as part of a revised induction programme. A new training initiative for all staff and volunteers working in patient and visitor facing roles is due to be introduced in 2023. Furthermore, a short teaching session is available to fourth year medical students who attend Mary Stevens Hospice for a day’s experience. Feedback has indicated that students value these sessions a great deal.
## **Events**
## **Summer Celebration**
Around 100 people attended the summer celebration event at St Mary’s Church, Oldswinford. The guest speaker was Dr Mike Blaber, a consultant in palliative medicine at West Birmingham and Sandwell NHS Trust. Mike’s address on the theme of hope was very well received. Alongside music from the hospice choir, poetry readings and lighting candles in memory of loved ones, the event focused on two aspects of our work at Mary Stevens Hospice:
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• In Patient Unit staff talked about their experiences and how they find inspiration to keep going.
• Promoting greater equality, diversity and inclusion was highlighted through a film from No Barriers Here.
The event concluded with blessings from volunteers representing different spiritualities (Christian Methodist, Humanist, Muslim, and Pagan).
## **Light Up a Life**
Approximately 350-400 people attended the Light Up a Life/ Tree of Light event at the hospice, with around 75-80 joining in the same programme of readings, music, and candle lighting at St Mary’s Church, Oldswinford a few days later. As always, both events were well received.
## **Christmas Concert**
The annual fundraising Christmas Concert took place at St John’s Church, Hagley Hall with about 150 people in attendance. The concert included the award-winning Sovereign Brass, Mary Stevens Hospice choir and soprano Emily Carew- Gibbs who provided a memorable evening of seasonal music, including carol singing for all!
## **Wassail**
In February, staff and volunteers gathered to wassail our iconic Tree of Light. The ceremony led by Awen Clement, Pagan Advisor, included blessings on both the tree and the hospice reflected different spiritual paths. Following the ceremony, refreshments were served in the Education Centre and music enjoyed from Catch the Rain, Tom Hill, Emily Carew-Gibbs and the hospice choir. Although the event is designed to lift the spirits of staff and volunteers, several people suggested the event could be of benefit to those we are supporting through bereavement.
## **• Inter Faith**
The spiritual care coordinator maintains a comprehensive directory of faith advisors covering all the major world religions, Christian denominations, and sects, as well as new spiritualities and secular worldviews. During the past year, efforts have been made to refresh the Dudley Borough Inter Faith Forum, a network that seeks to build relationships and understanding between people of all faiths and none. It also aims to support faith communities in acting together for the benefit of the whole community. The spiritual care coordinator attended events during Inter Faith Week 2022 and is planning to continue to build links with the Inter Faith Forum during 2023/24, including inviting different faith representatives to visit the hospice so that we can learn from one another.
## **• Association of Hospice and Palliative Care Chaplains (AHPCC)**
The hospice spiritual care coordinator has continued to facilitate the Midlands Group of AHPCC which offers support and insight into best practice. Over 40 people subscribe to the group mailing list (‘Midlands’ covering Grimbsy to Hereford and Shrewbury to Milton Keynes!) with meetings usually held online. Hybrid meetings are planned for 2023/24.
## **• Birmingham and Black Country Chaplaincy Collaborative (BBCCC)**
The BBCCC brings together healthcare chaplains and spiritual care leads of all persuasions. In addition to mutual support and reflection on practice, the group offers training to volunteers.
## **Networking**
During the year, an Anglican priest from Brierley Hill joined us for their final placement as a curate supervised by the spiritual care coordinator. We anticipate that this person will be joining the spiritual care team in a voluntary capacity from March 2023.
33
## **Volunteer Service**
## **April 2022 - March 2023**
Volunteers are significant to the day-to-day running of the hospice and are vital to the care and support that we provide to patients and visitors. We began in April 2022 with 73 volunteers working within the hospice. Staff, volunteers, and visitors were still required to do lateral flow tests, and volunteers were instrumental in supporting the testing procedure until May 2022.
In February, we resumed referrals for the volunteer community companion service where patients receive home assessments and are matched with suitable companions. A small group of existing community companions returned to visiting patients at home and the number of companions has increased to 11.
During April, volunteers resumed working within the clinical areas of the hospice but compared with pre-pandemic, the number of volunteers had declined. Several returning volunteers requested alternative roles outside of clinical and patient facing areas. We have continued to invest in recruiting volunteers to work in these areas, but progress has been challenging.
Throughout the summer the hospice saw a slow increase in the number of returning volunteers, but it demonstrated the need for further recruitment in this area. We later launched a recruitment drive, with advertisements in the local press and social media platforms, promoting the community companion service and calling for people to become involved in volunteering. There was a steady response and new volunteers were recruited who undertook induction training in January 2023.
During the time under report, volunteers were supported in groups through scheduled supervision meetings. Moving forward, the overarching aim is to continue to invest time and resources to expand the volunteer team, with a focus on clinical areas and the community companion service.
Volunteers provide a significant role in hospice care and their time and support is of immense value to the hospice. To celebrate our volunteer team, we hosted an event to show our gratitude for the service they provide. This was held in September and took place in the Day Service Unit, with volunteers reconnecting with others, partaking in afternoon tea and listening to live music on the patio area.
The figures below depict the breakdown of volunteer numbers at the end of March 2023.
99 Total volunteers 3 6 Admin Wards 60 Reception 3 Drivers 6 Gardeners 11 Community 5 Companions Bereavement 5 Day Services
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## **Fundraising**
**----- Start of picture text -----**
April 2022 - March 2023
Charity auction: £4,200
Corporate sponsorship: £500
Held at Stourbridge FC. West Total raised: £10,015
Midlands Legends XI v Stourbridge
Old Boys. Attendance = 1500
The charity auction raised
over £4,200 which included an
incredible £1,000 for a signed,
framed Jude Bellingham shirt,
donated by the player himself.
Corporate sponsorship: £140
Total raised: £7,000
Gross: £22,805
Net: £10,149 A day out in the
community, hosted
by The Tenth Lock
pub and sponsored by
Canalside Tackle and
Taylors Estate Agents.
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Corporate sponsorship: £140
Total raised: £7,000
Gross: £22,805
Net: £10,149 A day out in the
community, hosted
by The Tenth Lock
pub and sponsored by
Canalside Tackle and
Taylors Estate Agents.
Three coaches full of
supporters were taken to
Ladies Day at Royal Ascot
Jubilee Hair Shave
Raised: £550.58
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Over 6,000 ice creams
were sold to local
school pupils during
the summer months.
Total raised: £6,500
ream Parlour
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Our Summer Fayre included
parade, dog show, stalls,
entertainment and Black
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opening by deputy Mayor,
Cllr Andrea Goddard.
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**----- End of picture text -----**
Corporate Sponsorship: £2,550 **Total raised: £18,250 d**
London to Paris Bike Ride **Raised: £6,492 r**
Worcester City Half Marathon **Raised: £1,270**
37
**----- Start of picture text -----**
Firewalk saw a return
Total raised: of a ‘group challenge’
sponsored event.
£6,500
Corporate sponsorship: £1,000
Total raised: £12,500
Total raised:
£12,000
Total raised:
£7,200
Land’s End to John O’Groats
Jigsaw Festival Total raised: £348
Total raised: £800
38
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Corporate sponsorship: £2,500
Gift Aid: £6,653.25
Total raised:
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Performed 14 sold out
shows to 8 primary schools,
The Mayor of Dudley, The
deputy Mayor of Dudley
Gifts in kind: and consorts, industry
Tress Surgeons: £7,500 professionals, sponsors,
Skip Hire: £2,400 celebrities and over 5,300
audience members.
Over 1,600 Christmas
trees were collected over
three days by volunteers,
covering 15 postcodes
reaching as far as Sedgley,
Kidderminster and Dudley.
Corporate sponsorship:
£9,716.67
Gross: £84,000
Net: £43,000
Gifts in kind:
£90,000+
Charity Party Night
Total raised: £3,150
Jigsaw Festival
Total raised: £2.401
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39
## **The Mary Stevens Hospice Lottery Limited**
## **April 2022 - March 2023**
The Mary Stevens Hospice Lottery is one of the ways for our supporters to help sustain the future of the hospice with the opportunity each week to win a share of the weekly draw.
In May 2022, we opted to decrease the weekly second prize place from £500 to £200, resulting in a saving of £15,600 per annum with the rollover of the second prize place still reaching the £10,000 maximum payout. Two big lottery draws with increased cash prizes have taken place during the year, enabling us to boost lottery ticket sales and help raise more money to support patient care.
## **Spring into Summer**
Spring into Summer took place during June 2022 with a lottery big draw and publication of lottery news within the hospice newsletter. £14,500 of income was generated from Spring into Summer tickets, with a further £7,000 from regular weekly players ensuing a total of **£21,500** raised.
## **Deck the Halls**
The second big lottery draw of the year happened during December 2022 with a further update published in the hospice newsletter. Sales from Deck the Halls tickets generated an income of £29,110 in addition to £6,707 from weekly plays resulting in **£36,260** raised.
## **Stourbridge Football Club**
In April 2022, we were delighted to partner with Stourbridge Football Club representing an exciting step for the lottery company. This included visual and digital engagement with two hospice lottery banners displayed pitch side, a direct link to the hospice lottery website page from Stourbridge Football Clubs website and promotion of the hospice lottery every Thursday via the club social media platforms (Facebook, X and Instagram). Furthermore, the club will host two charity days at matches of our choice, with up to 30 guests and the opportunity for the lottery team to sell tickets face-to-face to supporters, promote
membership of the lottery and engage with the local community about the hospice.
## **Mary Stevens Hospice Lottery and Trading Company**
Between February and March 2023, the team commenced plans for supporters to purchase single weekly lottery tickets in Mary Stevens Hospice shops, enabling us to potentially increase the number of people playing the hospice lottery each week.
Prior to its roll out due in April 2023, a lottery module was installed on the shop EPOS systems. Operational training was given to shop managers and additional training delivered to shop staff and managers, including guidance on the hospice gambling process, legislation, legal restrictions, and addiction support.
40
**Trading Report**
## **April 2022 to March 2023**
The year under report was Trading’s first ‘full’ year since the pandemic. With the uncertainty of the cost of living crisis, it was unknown the impact that this would have on the business or the effect on staff and volunteers.
During this year, we invested in improving technology within the shops, replacing the EPOS system, and upgrading to capture digital gift aid. Additional time was invested in developing the Donor App, resulting in considerable changes in the way that we work but providing efficient and easier to manage systems. It enabled the shops to resume selling hospice lottery tickets, with the new system generating tickets upon point of sale. The new systems have additionally provided the opportunity to look at the data and identify the gaps in gift aid. With a change of practice, we have already seen a 30% increase in gift aid income with a projected value of £115k for 2023/24.
Energy costs also caused concern within this period; with potential astronomical increases we secured fixed short-term rates to take us through the year. Despite this we, experienced an increase of 60% in energy costs for the year. A 6.6% increase in the National Minimum Wage affected expenditure on salary budgets. In addition, long-term sickness and agency costs has inevitably resulted in a salary overspend for the period under report.
From April to Christmas 2022 donation levels remained strong, despite the charity sector experiencing a decline from October onwards. Since Christmas we have observed a decrease in both the volume and quality of donated goods. However, through having a central sorting facility we have maintained good reserve stock within the Distribution Centre. Unfortunately, one impact from the cost of living crisis was suppressed eBay sales, varied income streams and a reduced reliance on income generated from eBay. This resulted in restructuring to a hybrid model to be tested over a 12-month pilot period. Sadly, the new model created redundancies within the department.
The pandemic and cost of living crisis predictably affected consumer shopping behavior with people being value led, either looking for a bargain or to make more sustainable purchases by buying fewer but better value items. We saw many new customers but also lost those who could not afford to shop. However, a change in people’s spending habits and environmental awareness established a popularity of purchasing second-hand and people who wanted to be associated with the growth. For the hospice retail shops and Coffee Stop, sales were strong and have outperformed the yearly budget, demonstrating a consistency in both sales and footfall and a real need for the shops to fulfill within the community.
Next year presents further uncertainty in the charity retail sector but will prove if this is sustainable when against the present level of buying in commercial retail.
41
**Structure, Governance and Management**
## **Governing Document**
The Mary Stevens Hospice Limited is a registered charity, number 517656 and is a company limited by guarantee governed by its Memorandum and Articles of Association dated 4 March 1986, as amended up to 2018. As outlined in our Articles of Incorporation, Mary Stevens Hospice exists first and foremost to promote welfare and relief of suffering so far as such purpose is charitable.
## **Recruitment and Appointment of New Trustees**
Diversity considerations have been focussed upon at Governance Committee and Main Board. Current policy includes advertising to recruit diverse interest in serving on the Board moving forward. Both Chair and CEO may be approached to discuss the role and responsibilities, and an induction programme is provided after interview.
## **Organisational Structure**
The Hospice is governed by the Directors who form the Board of Trustees. The Directors are volunteers who have or have had careers in a wide variety of business and professional activities. They usually come from the Dudley Metropolitan Borough and its surrounding districts. All elected Directors are also Trustees; the names of the Directors are listed below. Two councillors are nominated by Dudley Metropolitan Borough Council to serve as Directors/Trustees. All nominees are subject to ratification by the Board of Trustees. The Charity is organised so that the Board of Directors of the Company meet regularly, with governance subcommittees (Hospice Governance, Finance & Resources, Clinical Standards, Fundraising Governance and Remuneration) reporting to it, whilst individual directors liaise with senior leadership on a regular basis. The CEO and the Senior Leadership Team are responsible to the Board of Directors for the day-to-day running of The Mary Stevens Hospice and the implementation of policies and strategies decided by the Board.
## **Statement of Public Benefit**
Trustees aim to observe the 2017 3rd edition Charity Governance Code to support continuous improvement in purpose, leadership, integrity, decision making and risk control systems, Board effectiveness, Board diversity and transparent accountability.
The charity operates a system of sub committees, each committee being focused on a particular aspect of the charity’s operations. That system is frequently reviewed and changes have recently been introduced to the style of main board meetings to improve their effectiveness.
The charity’s objective and its principal activity is that of providing palliative and end-of-life care for those with progressive incurable life shortening illness. The activities of the Hospice are of benefit to the public generally and the Trustees actively encourage the availability of the services to all members of the public irrespective of race, gender or any other discriminatory factor. That system is frequently reviewed, and changes have been made to the style of Main Board meetings, independent Chairmanship of Lottery and Trading Boards established, and all Governance Committees strengthened in the 19/20 year.
The Trustees confirm that they have complied with the duty in section 17 of the Charities Act 2011 to have due regard to public benefit guidance.
42
## **Reference and Administrative Details**
**Registered Company Number: 1963989 (ENGLAND & WALES) Registered Charity Number: 517656**
**Charity’s Principal Address & Registered Office 221 Hagley Road | Oldswinford | Stourbridge | DY8 2JR**
## **Trustees**
P Marsh J Turner B Blakemore S Hodgson A Lees N Dace - _resigned 16 May 2023_ S Waltho D Martin K Shakespeare E Flint Bridgewater B Coles A Bagnall - _resigned 1 November 2022_ J Graham - _co-opted 16 November 2022_ S Masters-Clark - _co-opted 8th August 2023_
## **Chair of the Lottery Board**
A Baker
There are no corporate Trustees and no Trustees hold title to any property belonging to the Charity.
## **Group Chief Executive**
C Towns BSc (Hons) Palliative Care
## **Matron & Registered Manager**
C Towns BSc (Hons) Palliative Care
## **Our Advisers**
**Auditors:** Crowe U.K. LLP, Black Country House, Rounds Green Road, Oldbury, B69 2DG
**Solicitors:** Higgs & Sons, 3 Waterfront Business Park, Brierley Hill, West Midlands, DY5 1LX Wall James Chappell, 15-23 Hagley Road, Stourbridge, West Midlands, DY8 1QW
**Banks:** NatWest Bank PLC, 141 High Street, Stourbridge, West Midlands, DY8 1BF Barclays, 1 Snowhill, Queensway, Birmingham, B4 6GN Metro Bank, 50 Two Woods Ln, Brierley Hill DY5 1TA
**Investment Advisers:** Canaccord Genuity Wealth, Slip House, Princes Drive, Worcester WR1 2AB
43
## **Reserves Policy**
The total funds of the group at the year end were £5,695,000 (2022 £6,077,000) of which £1,233,000 were restricted (2022 £1,198,000). Funds of £3,522,000 (2022 £3 712,000) were designated for the specific purposes of a possible Hospice at Home service, £200,000 (as last year) and fixed assets £3,322,000 (2022 £3,512,000), the latter being capable of being realised only by a disposal of fixed assets. Unrestricted free reserves of the group at the year end were £940,000 (2022 £1,167,000).
to 6 months’ running costs and last did so on 31 March 2019. The current level of reserves is insufficient to attain that target, representing only 3 or 4 months’ running costs. The Trustees anticipate some improvement in the level of free reserves during the current year due principally to the level of legacy receipts.
Reserves, being unspent, unrestricted income held to assist in the management of the Hospice’s cash requirements, are important as approximately 85% of the Hospice’s income is from volatile sources such as donations, legacies and fundraising events.
The reserves are held only to assist the Hospice to continue to provide its charitable services. The Hospice seeks to have reserves equivalent
## **Investment Policy**
The Trustees have responsibility for the Hospice’s investment policy and have delegated the management of the investment portfolio to professional investment advisers, the appointment of whom was reviewed and confirmed during the year.
The advisers seek to achieve a reliable income, needed to support the running costs of the Hospice, and to maintain a balanced approach between income and capital growth. Investments in assets which may be detrimental to the Hospice’s charitable objects are avoided.
This brought about a re-pricing of interest rate sensitive assets which impacted upon the capital value of the trustees’ investments. The overall asset allocation of the investment portfolio on 31st March 2023 showed that approximately 15% of the fund was invested in debt & fixed interest investments, 60% in equities and 15% in alternatives. A higher than usual balance of 10% of the fund was held in cash. The overall income yield from the investments stood at 4.3%.
During the last financial year, the total return from the investments resulted in a fall in value of 6.98% down to £1,273,477 during a year of difficult global stock market conditions. The peer group equivalent performance saw a fall of 5.52%. The overall investment backdrop was one of continuing war in Ukraine with a resulting strong rise in inflation and significant increases in interest rates for the first time since 2008.
44
## **Going Concern**
We, the Trustees, set out in this report a review of the financial performance, risk management policies, the reserves position and other factors likely to affect the future development of the Hospice. We have concluded that despite the continuing wider economic uncertainties there is no material uncertainty that calls into doubt the charity’s ability to continue. The financial statements have therefore been prepared on a going concern basis. More information is included in the accounting policies.
## **Trustees / Directors Indemnity Policy**
Insurance arrangements are in place with AXA Insurance PLC to indemnify Trustees/Directors. The policy number is LS BDX 6985610/0108 and the indemnity limit is £3,000,000. The premium paid was £3,088.56
## **Accountability**
To Finance and Resources and Governance Committee and Main Board
## **Pay & Remuneration**
Remuneration of personnel and senior management is approved by the remuneration committee constituted as below. Whilst we are aware of NHS pay scales, we do not at this time offer matched salaries, but a comparable system which is governed by our financial constraints as an independent Hospice.
A 5% general pay rise was awarded across the organisation once again in April 2023.
## **Membership of the Remuneration Committee:**
_CEO Claire Towns Peter Marsh (Chair) John Turner (Vice Chair) Dr Jane Flint Bridgewater_
## **Quorum of Meetings**
All present for annual meeting to make above decisions and any exceptional individual awards.
45
## **Financial Reviews**
The financial results for the year ended 31 March 2023 are given in the audited Financial Statements attached to this report. Those accounts and the related notes have been prepared in accordance with the relevant law and the Charities SORP (FRS102).
The financial result for the year was a disappointing deficit of £382,305, the result for the previous year being break-even. However, as a large part of this deficit was attributable to depreciation and to the fall in value of the investment portfolio, cash of £90,346 was generated.
Despite the ending of the Covid related government support, which generated income of £294,381 in the previous year, the total income from all sources, £4,936,729, was £173,792 greater than that of the previous year. The slow recovery of the economy after the Covid 19 pandemic, the inflationary impact of the war in Ukraine in terms of energy costs and more particularly in relation to wage levels resulted in the growth in income not matching the growth in costs. The principal cost, namely salaries, is further affected by the terms of employment within the NHS, another factor outside the control of the Hospice.
The costs of providing patient care rose by £194,821 to £3,199,586. Even greater cost pressures were experienced in relation to fundraising activities. Including the Hospice’s subsidiaries, where utility costs and the National Minimum Wage play a greater role, the total costs of fundraising rose by £196,650 to £1,638,363.
The year saw a further welcome improvement in legacy income, from £823,079 last year to £919,265 while the amount received from the Integrated Care Boards fell from £538,032 to £519,424. Donations, including those from charitable trusts, rose by £125,886 to £757,832.
contend with so many cost pressures resulted in the profit for the year being £15,594 lower than the previous year at £176,181.
The Lottery company experienced a decrease in turnover but through improving its operating model succeeded in generating a profit of £252,211, only £13,456 less than the previous year.
The Hospice’s cash position improved slightly during the year £1,048,345, an increase from £983,511 at the end of last year. The Hospice also had an investment portfolio of listed securities with a value of £1,273,477 at the year-end (£1,422,476 on 31 March 2022).
The continued economic turbulence brought about by Russia’s war with Ukraine and the consequent increases in energy prices and in general inflation is forcing the Hospice to confront increased costs while simultaneously putting pressure on its income sources. The retail shops and the lottery are remaining profitable but their ability significantly to increase profits remains limited. Fortunately, the pipeline of legacy income is currently buoyant and the legacy income for 2023/24 should be at least £500,000 greater than that for 2022/23. The local NHS Commissioners have also accepted the need to provide additional funding and the Hospice has worked closely with them to achieve that outcome. The Hospice continues to attempt to obtain specialist palliative care status and to forge closer links within the healthcare community.
The Trustees continue to monitor carefully the resources of the Hospice as its long-term financial viability is their primary concern.
The Hospice’s retail shops were again impacted by the general malaise affecting the high street sector and specifically the pressures mentioned earlier but nevertheless succeeded in growing turnover by £265,446 to £1,630,572. The need to
46
**Statement of Trustee Responsibilities**
The Trustees (who are also the directors of The Mary Stevens Hospice Limited for the purposes of company law) are responsible for preparing the Report of the Trustees and the financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice).
Company law requires the Trustees to prepare financial statements for each financial year which give a true and fair view of the state of affairs of the charitable company and of the incoming resources and application of resources, including the income and expenditure, of the charitable company for that period. In preparing those financial statements, the Trustees are required to:
Select suitable accounting policies and then apply them consistently
Observe the methods and principles in the charity SORP
Make judgements and estimates that are reasonable and prudent
Prepare the financial statements on the going concern basis unless it is inappropriate ti presume that the charitable company will continue in business
The Trustees are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the charitable company and to enable them to ensure that the financial statements comply with the Companies Act 2006. They are also responsible for safeguarding the assets of the charitable company and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.
In so far as the Trustees are aware:
There is no relevant audit information of which the charitable company’s auditors are unaware
The Trustees have taken all steps that they ought to have taken to make themselves aware of any relevant audit information and to establish that the auditors are aware of that information
Exemptions from disclosure Nil.
## **The Board of Trustees declare that they have approved the Trustees’ report incorporating the Directors’ Report and the Strategic Report.**
## **Signed on behalf of the charity’s Trustees**
Signature: Full Name:
Position: Date:
47
**Hospice Care** – 01384 443010 **| Fundraising** – 01384 377778 **| Lottery** – 01384 860011 **Trading & Recycling Centre** – 01384 671149 **| Telephone Information Line** – 01384 445417 **Bereavement Information Hub** – 01384 443010
Report produced by **Beth Wheeler, Graphic Designer**
@marystevenshospice
@marystevenshospice
@MSHospice
@ The Mary Stevens Hospice
Registered Charity No. 517656
THE MARY STEVENS HOSPICE
{A company IlmStèd by guarantee)
INDEPENDENT AUDITOR'S REPORT TO THE MEIABERS OF THE MARY STEVENS HOSPICE
Oplnlon
We have audited the financial slatements of The Mary Stevens Hospico Ithe'parenl charitable company'} and ils
subsidiaries Ilhe 'group'i tor the year ended 31 March 21Y23 which compfise the Consolidated statement of
financial activities. the Consolidated balance sheet, the Company balance sheet, the Consolidated slalemenl of
cash flows and the relale(I notes, including a summary of significant accounting policies. The linancial reporting
framework that has been applied in their preparation is applicable law and United Kingdom Accounting
Standards, including Financial Reporting Standard 102 'The Financial Reporting Standard 3pplicabl& in the UK
and Republic of Ireland (United Kingdom Generally Accepted Accounting Pradicel.
In our opinion the financial statements..
give a true and fair view of the state of the Group's and of the parent charitable company's affalts as at 31
March 2023 and of the Group's incoming resources and application of resources. including its income and
expenditure for the year Ihen ended."
have been properfy prepared in accordance with United Kingdom Generally Aepted Accounting
PrabtiGe, and
have been prepared in accordanc4 with the requirements of the Companies Act 2006.
Basls for oplnlon
We conducted our audit in accordance with International Standards on Auditing IUK) IISAS {UK}l and applicable
law. Our responsibilitlgs under thos8 Standards are further descritr)èd in the Auditorfs responsibilit18$ for the audit
of the financial statements section of our report. We are independent of the Group in aecordanee with the ethical
requirements that are relevant to our audit of the financial statements in the United Kingdom, including the
Financi81 Reporting CoLFn¢il'$ Ethical Standard. and we have fulfilled our other ethical r8sponsibililies in
accordance with these requirements. We b¢lieve that the audit evidence we have obtained is sufft'cienl and
appropriate to provide a basis for our opinion.
Conclusions relating to golng concom
In auditing the financial slalemenls, we have concluded that the Tluslee's use of the 90ing concern basis of
accounting in the preparation of th$ financial statements is appropriate.
Based on the work we have perfomied. we have not identrfied any material un¢ertainties relating lo events or
condrtions that, indiv¢dualty or collectively, may co?t signilicant doubt on the Group's or the parent charitable
companls ability lo continu& as a going concem for a period of al leasl twelve months from when the financkal
statements are aulhorised for issue.
Our resportsibililies and the responsibilities of the Trustees wrth respect to going concern are described in the
relevant sections of this feport.
Page 48
THE MARY STEVENS HOSPICE
{A company limitad by guarant991
INDEPENDENT AUDITOR'S REPORT TO THE MEMBERS OF THE MARY STEVENS HOSPICE
ICONTINUEDI
Other infomlatlon
The other information comprises the informatson included in the Annual report other than the financial statements
and our Auditorfs report Ihereon. The Trustee are responsible for the other information contained within the
Annual report. Our opinion on the financial statements does not cover the other information and, except lo the
extent otherwise explicitly slated in our report. we do not express any form of assurance conclusion thereon. Our
responsibility is tts read the other information and, in doin9 so, consider whethor tho other snformation is
materially inconsistent with the financial slalemenls or our knowledge obtained in the course of the audit, or
otherwise appears lo be maler¢ally misslaled. If we identify such material inconsistencies or apparènt rn8tèri81
misstatements, we are required lo determine whelheT this gives iisè to a material misslalement in the financial
statements themselves. If, based on the work we have performed, we conclude that there is a material
misstalemenl of this other information, we aTe required to report that fact.
We have nothing to report in this regard.
Oplnlon on other matters prescrlbed by the Companies Act 2006
In our opinion, based on the work undertaken in the course of the audit..
thè irsfomiation gw8n in the Trustee's Rgport including tho Strategic Rgport for the financial year for which
the financial slalements are prepared is consislenl wi(h the financial slalements.
thè Trugteè's Rèport and the Strategic R8port have be&n pr•par8d in accordanco with applicable legal
requirements.
Matters on whlch we are requlred to report by exceptlon
In the Ih1 of our knoedge and undelslanding of the charitable company and ils environment obtained in the
course of the audit, we have not identified material misstalemenls in the Trustee's Report including the Strategic
Report.
We have nothing lo report in respect of the following maller8 in relation lo which Companies Act 2006 requires
LSS lo report to you if, in our Opinn..
the parent charitable company has not kept adequate and sufficient accounting records, or reluTns
adequate for our audit have not been CeIVed from branches not visited by us., or
the parent charitable company financial slalements are not in agreement with the accountin9 records and
returns., or
certain disclosures of Trustee's remuneration specified by law are not made., or
we have not received 211 thg information and oxplanations we roquire for our audit.
Page 49
THE MARY STEVENS HOSPICE
IA company Ilmlted by guarantee)
INDEPENDENT AUDITOR'S REPORT TO THE MEMBERS OF THE MARY STEVENS HOSPICE
{CONTINUEDI
Re$pon$lbllltles of Trustees
As explainett more fLblly in the Trustee's responsibilities statement, the Trustees Iwho are also the Dlrectors ot
the charitable company for the purposes of company lawl are responsible for the preparation of the financial
statemonls and fgr being satisfied that they give a true an(J fair view, and for such internal control as the
Trustees determine is necessary to enable the preparatton of financial statements that are free from material
misstatement, whether due to fraud or eTror.
In Pfoparing th8 financial statements, the Trustees are r8%pon8hlp for assessing the GroLJP'S and the parent
charitable companys ability lo continue as a going concem, disclosing, as applicable, matters related to going
concem and using the going concern basis of accounting unless the Trustees either intend to Siqui(late the Group
or the parent charitable company OT lo cease operations. or have no realistic alternative bul lo do so.
Aud5tor's responsibilities for the audit of the financlal statements
Our objectives are lo obtain reasonable assurance about whether the financial statements as a whole are free
from material misstatement, whether due lo fraud or error, and lo issue an Auditorfs report that includes our
opinion. Reasonable assuranee is a high level of assurance, bul is not a guarantee that an audit conducted in
accordance with ISAS IUKI will ay$ detect a material misstalemenl when il exists. Misslalemenls can arise
from fraud or erior and are considered material if, individually or in the aggregate. Ih6y could reasonabty be
expected to influence Ihe economic dlS1on$ of users taken on the basis of these financial statements_
IegUlaritIeS. including fraud, are inslanco5 of non in debtors
Increaselldecreasel in creditors
236,944
144,216
159,935)
18501
163,322
1,766
240,299
T,568
(53.505)
3,802
(37,523)
{70.876)
Net cash provlded by operatlng actlyltles
90.346
89,456
24. Analysls of cash and cash equlvalents
Group
2023
Group
2022
Cash in hand
Cash held in investments
1,048.345
122.401
983,511
3,647
Total cash and cash equlvalents
1,170.746
987, 158
25. Analysls of changes In net debt
Other non-
cash At 31 March
changes
2023
At 1 April
2022 Cash flows
Cash al bank and in hand
983,511
3,647
187,0061
(927.3101
64.834
118,754
36.866
1.048.345
122,401
193.6911
1863.8601
Cash held in investments
Debt due within 1 year
Loans due after 1 year
163,4S01
63,450
7.1581
220.453
213.295
Page 81
THE MARY STEVENS HOSPICE
(A company Ilmltod by guarantee)
NOTES TO THE FINANCIAL STATEMENTS
FOR THE YEAR ENDED 31 MARCH 2023
26. Penslon commltmonts
staff may opt lo join a defined contribution pension scheme, the assets of which are held separately from
those of the eharily in independently administered funds. The employerfs contribution to this scheme is
between 3/0 and 6.50A12022'. 3&A and 6.50AI of pensvjnable pay. Future ¢ontr¢bulions are expected to be
at a similar level.
Staff previously employed by the Nats'onal Health seice and who weTe members of the NHS
Superannuation S¢h¢m¢ wntinue to be members of that Scheme. The NHS 8¢heme is a d¢fined ben¢fit
pension scheme. However. the scheme is a mvlliple employer scheme and thè group is unable to identify
s sharo of the underlying assets and liabilities. The sch8me is therefore secounled for as a d8fin8d
contribution scheme. Contributions are charged to the SOFA so as lo spread the eosl of pensions over
employees. working lives with the charity.
Details of the benefits payable under these provision5 be found on the NHS Pensions website at
www.pensions.nhsbsa.nhs.uk.
Th? ¢mployerf5 Gontribution to the scheme is 14.38°h12022: 14.38%) of pensionable pay.
The pension cost charges. representing employer's contributions to both schemes, amounted to £134.010
12022.. £137.1291. This is net of a NHS pension contribution of £43,563 {2022.' £43.5631 received as part
of the Dudley CCG grant. Contributions totalling £Nil12022.. £Nil} We payable al the year end and are
included in olheT creditors.
No Lrustee qualified for benefsts under eit[ ol th¢s¢ sfjh¢m¢*.
27. Operatlng lease commltments
Al 31 March 2023 the GroLtp and the Company had commitments lo make futL¢re minimum lease
payments under nOn-CanlIable operating leases as follows..
Group
2023
Group
2022
Company
2023
Company
2022
Not later than 1 year
Latei than 1 year and not later than 5 years
Later than 5 years
151.254
399,650
23,184
185.969
392,253
69.553
16,844
38,042
6,484
20,753
574,088
647.775
54.886
27,237
28. Members. Ilablllty
Ea¢h m¢mber of the charitable Gompany undertakes to Gontribute to the aa¥o>t¥ of th¢ compathy in the
event of it being wound up white helshe is a member, or wrthin one year after helshe ceases lo be a
member, such amount as may be required. not èxceeding £1 for the debts and liabilities contraded before
helshe ceases lo bo a member.
Page 82
THE MARY STEVENS HOSPICE
IA company1Smltad by guarantee)
NOTES TO THE FINANCIAL STATEMENTS
FOR THE YEAR ENDED 31 MARCH 2023
29.
Related p8rty tran8octions
Thère have beèn no other related party transactions that requirè diAtlosurÈ othèr than thè trxn#adion$
with the subsidiary companies, The Mary Stevens Hospice Trading Company Limrted and Mary Stevens
Hospice Lollery Limited, as set out below..
Income from donated goods under the retail Gift Aid seheme are sales which were Pro$Sed by The
Mary Stovens Hospv Trading Company Limited on behalf of Ihe Charity and are included under reiail
income.
The ¥ub$idiary companies also made a gift aid distribution to the Charity as disclosed in Note 30.
The balance outstanding al the year end owed from The Mary Stevens Hospice Trading Company
Limited was £98,53912022 - £155.6451.
The balance outstanding at the year end owed from Mary Stevens Hospice Lottery Limited was £200,979
12022- £174,522}.
Page 83
THE MARY STÉVENS HOSPICE
IA company Ilmitéd by guarantee)
NOTES TO THE FINANCIAL STATEMENTS
FOR THE YEAR EMDED 31 MARCH Z023
30. Pflnclpal subsidiarles
The Charity ha5 two wholty owned trading subsidiaries which are regislergd and incorporated in England.
The following were Subsidiary undertakings of the company..
Names
Company
ntsmbor
The Mary Steven Hospic& 02648133
Trading Company Limited
Registered offlce or
prlnclpal place of bugines#
221 Hagley Road,
Oidwinsford, Stourbridge,
DY8 2JR
Prln¢lpal actlvlty
Sells goods and gift
aids taxable profits to
The Mary Stevens
Hospice
Runs a lollery and gift
aids taxable profits to
The Mary Stevens
Hospice
Mary Stevens Hospice
Lollery Llmited
03885815
221 Hagley Road,
Oldwinsford, Stourbridge,
DY8 2JR
The financial resuh$ of the subsidiaries for the yeaT-.
ProfitllLoss)
forthe year
Net
assetsl{liabllltlesl
Name
The Mary Stevens
Hospice Trading
Company Limited
Mary Stevens Hospi
Lottery Limited
Incom•
Expenditure
1,874,444
1,498,263
176,181
18,103
422,721
170,510
252,211
4,480
At the end of the flnanclal year. Mary Stevens H05pice Lottery Liwnited made a gift aid di5liibutioii of
£249.45812022'. £265,740) and The Mary Stevens Hospice Trading Company Limited made a gift ah
Ilistribution of £158,07812022.. £166,832).
Page 84
Rys
fyospicl
Hospice Care - 01384 443010 | Fundraising - 01384 3777781 Lottery - 01384 860011
Trading & Recycling Centre - 01384 6711491 Telephone Information Line - 01384 445417
Bereavement Information Hub - 01384 443010
Report produced by Beth Wheeler. Graphlc De$l8ner
mateVenst1)sPICÈ
@nK4rysLevenshosplce
@MSHospice
in
*TheMary Stevens M05p1
Registered Chafity No. 517656