REGISTERED CHARITY Dt(TTr(BER: 519767 REPORT OF THE TRUSTEES AND AUDITED F[NA￿CIAL STATEMENTS FOR THE Y£AJi ENDED 31 MARCH 2024 FOR ST. cimTBERT'S HOSPICE DURHAM Sumer Auditco Limited Tbe Beehive Building Beehive Ring Road CTawley RH6 OPA ST. cufHBERT'S HOSPICE DURJIAM CONTENfs OF THE ETrI￿NcIAL STATEhlENrs FOR THE ENDED 31 IIIARCH 2024 Page Report of the Trnstees I to 14 Report of the Independènt Auditors 15 to 18 Statement of Fin3tyci#l Activities 19 Balance Sheet 20 CAsh Flow Statsment 21 Notes to the C￿h Flow St&temeDt Notes to the FinaneiAI Ststewtnts 23 to 39 ST. CtrrHBERT'S HOSPICE DURUAM REPORT OF TBE TRUSTEES FOR TKE YEAR ENDED 31 JL4RCH 2024 The tr￿Stee$ present their report V*lth the finaneial statements of the cbaTity for tbe yw ended 31 M￿ch 2024. The ustees have adopted the provisions of Accountiog and RepO￿g by Charitids: Starement of Recommended Practice applicable to ¢lJaTities prcparing their aecouuts in acc￿danCe with the Fillancial Reporting Stalld￿d applicable in the UK and Republic of Ireland (FRS 102) (effective l January ?019). Objeetives and airns The Clwity's Objects. as set out in its Constitutio￿ are: To promote the relief of sickness of persons frorn County Durham aDd the North Fast of England generally suffering from a life-limiting or other illtiess and the provision of care and support to their faD]iLies and Lxrer4 and the advancernent of heatth and education by the promotion and developrnen¢ of kn¢)wledg¢, attitud&s and behaviours which enable people to pryare for death andlor live with life-limiting illnesses. Strateglc goals tn fjjrtherance of these Objects, th¢ Tnjstets have detetmined five strategic goajs: ro enable people at the very end of17fe to achieve a good death in the place of their ehoosing. To enable people living WAth a life-limiting illness who use Hosplce services to live well and make every day count To provide the infonnation and support that caros ofpeople with lif&limiting illnesses need to provxde the care they want to provi(k. To support those who have been bereaved as t consequence of a Iife-lirniting illness to adjust to life without their loved one. To break down the taboos associated with dyin& deatl loss and grief. Page I ST. CtrniBERT'S HOSPICE DURILAM IiEPORT OF TRUSTEES FOR THE YEARENDKD 31 MAIiCH 2024 OBJECTIVES AND AcfiviTJES We offer a 10-b¢dded Jn-patient UniL providing cart for guests (patienLS. and their families and carers) who need a break and c2n benefit from the specialist care we provide, for guests who are at a point in their illness where they Iieed h¢lp to manatre ther symptoms and carl benefit from th¢ s￿lalISt iDterventiOD6 we can off¢r. and for guests who ar¢ at the end of life and need the support tbat St CuthberV5 can provide to ensure they Can die peace5￿y, with dignity gAd witb their needs and wisbes met as far as is possible. Care in the unit is provided by a specialist team of doctors, nurses, healtbcare assistants and otber clinical aud non-clinicai specialists, as well as voluntrer4 who work together as a team to pmvide the best Ggre we can. We do tbis beeause we want to make the end of a person's life as comfortable a6 P￿1￿1¢. This is dont by attempting to relieve paill and other distressing symptoms while providiD8 psychologi￿1, soeiat and spiiiwal supporL Carers and family are also offered emotional ond spiritJJal SUPPOTL This is Called att ￿011stiC, approach to care. Our in-patient unit is smaller and quieter than a hospitsl and feels rnore like a home. Because of our size, because of our ethos, and because of the ￿perienCe and training of our stsff and volunteers, we ¢an provide indiv1th￿l we n]ore suited to tbe person in a gentler and calmer atrnosphere. We nm Day Care Servic&s for people who want to remaiti at home but want to visit the Hospice dujing the day. We gtve them the care and support they lleed without them having to move from home. A key part of this seNice is the Living Well Centre. Care in the Liling Well Centre is provided by a small healtbcore tean] 8nd with the support of a large teath of volunteers. tnput is also provided by ail the other spe¢iaiist staff in the Hospice who can be called upon to help meet the particular nee¢lq of indivittual guests, including physiotherapists, an occupatioD81 thernpist and ¢omplement8ry therapists. Each 8uesr has a personal care plan tliac aims ￿ meet their individual oeeds tI￿ough a range of a¢tiviLits and interventions. In tbe Living Well Centre, 8uests are able to access rn0￿ scrvi¢&s than they could if they were at home. Th&se include creative and complemeotary therapies a￿d rehabilitatio￿ &8 ￿'ell as nursing arLd medica] care. They atso meet other patients aDd can gain great ¢motionai and social support from people who are having similaT experiences. W¢ nm a bereavement support service for the f8miLies and earers of pwple witEk life-limiting illnesses. This involv¢s giving practical and COUDselling support both through tbeir loved-one's illness and ttwough the e8Jly Stages of bereavemeDt, typically for up to 12 months. Tbis service is provided by both paid staff and volurjteers. The Bereivernent Support Team also delivers a specialist savice for bcreaved cbil(Iren and young people. Jn addition, bereavement pre-diS[￿ses people to physical and mental ill-health and $0 ongoing support eall belp to ensure the health and well-being of our community. Moreover, wid] other parts of our wort volunteers wbo give of themselves and offer their time to support ber¢8ved people are involved as compassionate citizens alld so belp build more corllpagsionate commuDiti¢s. Our Day Services includes a social work team oJ)d voluDteer chaplaitLS, who offer practical. emotional and spiritual support to patients and families. This holistic approach to care has been intrgtal to the Hospice movement since its inception. Dame Cicely Sauaders famously sai¢ "How someon¢ dies ren)ains in the memory of those who live on" We extend our spe¢ialised knowledg¢ to those delivering palliative and end of life care in other settings. This support rang￿ from providing telephone consultstions to participating in team meetings with other care providers. Additionally, we open our staff and volunteer trailling prOgrarIIll￿ to other or47anisations, hosting sessions on palliative skills and knowledge. We etDploy COrnm￿ty development w0￿er$ whose role is to ¢r¢&te pubjic discussion about d¢atty grief and lo and to assist local coo]LDUDities to provide effective 5UPPOrt with life-limiting iljness ST. CUTHBERT'S HOSPICE DURWt REPORT OF TKE TRL'STEES FOR ThE YEAR ETr*l)ED 31 MARCH 2024 ORfECTtVES AND ACTMTKES We also provide a specialist service for people living with derneDlia and their earers. We employ a specialist dementta ¢are nurse. This nurse. an AdD)iral Nurse. wo￿$ a p￿ of team of three staff who work in tbe Hospice and in the community to protnote end of life care for people ￿llth advanced demenria. We have also developed 2 pi"otsfwT]me of support c￿led Nam&8te C￿e which is delivered ntsinty ill the homes of people Iivillg with dementi& The N2maste 8PPToad] is an intemationally recognised and stsucbjred pTogtsn￿e of care developed by PTofes50r Joyce Simard in the USA in 2003. It integrates compassionate nursing care with indiv1duaIise￿ nLe2niDgfill activities for tbose living with advauced dernenti& It offers indtvith]ais digulty. comforL aDd a ￿ sense of well-being and reduces isolation for theni their families 2nd carers. Mi$sion, VAsion and Values OverEII. our mission is to rnake every day wunt for thos¢ affected by life•limAting illnesses. Our vision is to be a c¢ntre of excellence within ow conm)unity and to provide all-embracing. compasstonate, and individualised care to all thos¢ affected by life-limtting illnesses, at a time and a place that is right for thenl OLW values are Professionaiisrffj RespeeL Choice. Compassion, Intcgtity, and ReputatiotL Phllosophy of Care We have adopted the following philosophy of care stateroent At the heart of St Cuthbert's Hospi¢e is the individual who is seen as a unique person duerving of respect and digoity. Our atm ts to support each person aud their family and frien¢L8, helpAng them to make infornied ¢hoic¢s end decisio￿ affecting tbeir liv¢s. Individual care is planned to support the total well-beirLg of each perso￿ la]ollg into account their physicaL psy￿01081¢a1, social aod spititual needs. We will work looether to provide a warm alld welcoming atm¢)sphere that accommodates divexse CUItt￿e$ and lifestyles within a calm and compassionate environmenL As a tw we will Strive to provide care of the highest standard by etisuring staff are up to date witb current research and training. We are aware of the valuable work undertakeD by individuats and agencies in the corLllnunity and we will work in partnership with them to provide excellent S￿vIceS for the people of DLth. We see life- and death- as a journey to be made in the compauy of other& We are rooted in our local Community and we 4)proacb life aod death thmugh a pbilosophy based on support and hospitslity. Public benefit The Charity Commission states tbat there two tests that must be p&ssed to meet the defjnition of pro￿dIng public benefiL' firstly, there must be an identifiable benefit or benefits. secondly the benefirfs) u]ust be to the public or a section of the public. The Trustees have 8iv¢n due consideration to the CTr￿1ty Conunission's general 8uidan¢e on public benefit ond are satisfied that the altus and objectives of the Charity. &$ set out in its c0j￿i￿ttOll and described in its n)Issio￿ visi04 values and philosophy of care statements, and its aciivities. &£ d&s￿1bed in this repoiL d¢monstrate that tbe Hospice satisfies these two tests. Page 3 ST. CUTHBERT'S HOSPICE DUIiHAM REPORT OF THE TRUSTEES FOR THE YEAR ENDED 31 MARCH 20 Strategic Goals Hospice provides s￿vI￿$ to five key targetpopulation4 &s set out in its Strategic Plan (2022-2027). Th￿e are: People at the very end of life People living with a life-limiting conditiou People wbo provide care informally to people Living with a life-limitiUE eondition People who have been bereaved by the death of someone with a lif¢-linJiling coudition The generdl public, because we want to break the taboo over talking aboul and responding to, deaty dying, grief and loss. People at the very end of life Looking back We support people at the very end of Itfe in our In-patient UDIL In 2023f24, 169 people died on the Unit (680/0 of totsi admissions), compared tr) 128 in the previous year (580/0 of totAL admissions). The cost of providing elld of life care was £1,442,273, an increase on last yea¢s COSL (2022123: £1,130,439). We are a8ain abl¢ to report on the impact of our work on tbi5 tsrget population in the Uut. As in 2022123, all our patients and carers who returned family and frien(Is feedback questionnaires reported baving confidence and trLLSt in the staff who were treating / caring for tbenL All rtspondents reported that they or theiT loved ones were treated with courtesy. respe¢ and digwty. We continue to play aD increasing role in supporting people to die well at hom4 if that is their choice, through the ¢oiYllttunity-based work of our Athniral Nurse 2nd Namaste Proje¢L olld tknrou8h etyective discharge p18nning by our In-Patient Team. In June 2023 our Medical Director left the Hospice and to we have been unable to recNit & replacement. The additional consultant pos¢ approved by the Trustees in 2023, Iw similarly proved a Challenge to recIuit to and remains vacallL Cor￿lItattt support has been provided through a seconthllent arrangement with the Trust and through the commissioning of remote Consui*nt supp)Th which has worked well. The continuation of this amngement bas r¢sulkd in us being able to welcome GP Registrars back to the Hospice iti August 2024. Looking f¢)nvard We will continue to collaborate with filrtber and bigber education iDStitiJtions and establish ourselves as centre for research and developmenL We will play an active role in the devclopmcnt of a new Palliative and End of Life Care sts7te8y for County Dllrh￿ focussing on adlieving a good death for more people. We will continue to promote equitable access to the Hospice for end-of-iife cary particularly among groups who have historically not accessed Hospi¢x care. We will publish the results of a local VOICES (Views of It￿0￿nal Carers Evaluating Services) survey. We wiIl work witb the Integrated Caft Boar¢L the County Durham and Darlington Foundatioa Tr￿8t and other partners to develop a sustainable model of medic81 cover for palliative and end of life care in tbe County. People Living with a LifÈ-limfttng Condition Looking Back During the year, 78 people were discharoed from the IPU of those admitted (320/0 of totsi admAssions). The LI￿ng Well Centre (LWC) delivertd 3857 face-to-face ￿SiOns. B¢reavcrnent Support Servi¢es dellvered 663 appoirAtrnents to 108 adults and 217 appointtnellts to 37 children and youno ￿Ople. The cost of providing palliative care £1,246,712. (a slight decrease on the previous year of £1,306,626). LoOk￿tr Forward Page 4 ST. CtrrHBERTIS HOSPICE DURHAM REPORT OF THE TRUSfEES FOR TAE YEAR Ef*l)ED 31 MARCE 2024 We will Collaborate with other Hospices inthe region to identify a eommon language to identify tkLemes and trends from clillieal incidents in order to identify aJ]d implement improvement Progran￿lle8. We TAqll optimise the use of botb the In Patient Unit and Living Well Centre We ivill implernent and evaluate enhanced thernpy provision follo￿￿llg the appointn)ent in 20?3114 of a rehabiLitation assistant People who provide care Informaity to people living wlth a ]ife-limiting condltlon Looking Back The family support team pathway continues to ¢onnect with the inpatienl day Servi￿ al￿ bereavement support pathways to offer seatntess service provisiott This iucludes anticipatory ￿]ef supporl caT4r support and praetical needs support {e.8., f)nances, benefits, housillg information and advice.) 2023Q024 bas seen an in¢r¢ase of voluntser ebaplaincy support from the local An8￿.Call faith c0nTrW￿ty. Service review in 20￿/2024 has identified the need for a more appropriate assesstllent tool in IPU and LWC. The Carer Support Asse&srnent Needs Tool (CSNAT) continues to be used ID the Dementi&-Namastr Service. The Livtng Well Centre (LWC) tearo are trta]Jing a 3-year paid Driver role to increase referrals aud occup8llcy. This is generating good r&wJlts, including the reduction of carer bwden in ternis of traLqporting service users to LWC. Sbort Courses of reiki relaxation therapies for Carers. continue to bc offered by the LWC complemelltary therapy trained staff. The Dementia-Namaste Service bas CODJmenced a weekly activity group in LWC to support people living with advanced dementia and their wers/spO￿8es. While the Conwnunity Outreach Service is working witb service users and carers in Chester-Le4treet area. W¢ continue to work with Oth￿ care support services aod primsry care networks, to offer support to a wide of cornmimity users. This includes Durban] County Carers Support (DCCS). Durham Alliance £or C¢)mmunity Care (DACC), The Alzbeimevs Society and The Bridge. Lookng forward We will implement the Carer Conversation Wheel in tPU and LWC as a way of me2surillg oul¢omcs. Continuation of the 3-year LWC thiver role alld review of outcomes. Continuation of therapies aud group activiti&s to support seNice ￿se[S and careTr. The cost of providing support to people providing care infotmaily was £73,450 an increase on the previous year (£59,560). People who have been bereaved by the death of someone with a life-lin￿ting ¢OllditEo We have seen significant prorn in bereavement support provision in 2023r2024, incluthng re¢rnitment and indu¢tion ill Q4 of a new Children's & Young Persons Counsellor, worlong 0.6 WfE. This has allowed for recrnitrnent of a additional 0.4 WTE Children's & Young Persons Counsellor in 202412025. We have reviewed seryi¢e provision will continue to pro￿de Family FUD Days with supFort from the Children's & Young Persons Counsellor. Adult bereavement support continu&8 to bc a high denjand servic< witb a sustsined referral rate and positive repoTted outeomes frn￿ service Use￿ We continue to have an effective support pathway betwee7) FaTnily Support and Bereavement Support te8Jns, to assure timely support This has been bolstered over 2023n024 with volunteer chaplain¢y support from the local Angli¢8ll faith conll￿ty. Dwing 202212023, we completed a review of our Hospice-wide Bereavement Support Joumey. This IJ&s allowed for innovatiotL% and iTnprovemenE contributiDg to the wider Support a￿lIabLe. Our Family Support Team h&ve provided guidance to our supporteLA iucludi4" Nortbeaft Chanlber of Con￿￿erce and the 88 club. io topics such as 'havin8 difficult conversations, and'supporting bereaved stsff., Page 5 ST. cufHBERT'S HOSPICE DtTRHAM REPORT OF TILE TRUSTEES FOR TIiE YEAR ENDED 31 MARCH 2024 iu 20?312024 wc continued with tbe successfid HoSpiccknW￿C B¢reavemeAt Support Journey wbicb covcrs aiL aspects of support provision. including serviee users, families carers, staff. voluDteth8 2nd donors. This work ylltegrdtes the whole Hospi¢e COllllllUDity. The cost of providing fomjily support Vlas £119229 (a sligbt iAere8se on the previous year 2021123. £109,190). Loo10￿tr Forward We will trial the use of translational therapeutic Obje￿ as a therapeutic iJ1terventio￿ especia)ly with children and young people We will move data collection on bereavement support to Systmone. our patient Tecord system We will celebrate outcomes of the developr(Letst of aHospic&wide ber¢ave￿ellt support joumey Wc will develop a comrnunity bereavement offer Pro￿dIllg Serriees to tbe Community- Community Outreaeh Project The CornmuDity Outreach Serrice has b¢en rLmDiDg for 18 months. These figures represent the period from l March 23 to 30 April 24. The team ts nnde up of 3 filll time posts fimded by Bis Lottery they &e: . Community Outreach Manager - Cornmuniry Outreach C¢￿rdinatOr - Narnaste Ct)-ordinator We have 0.5 wfE support from the Adrnir￿ Nurse 2nd a Dementia Support Worker who is contwted to work 26 hours per week. Stsff are tlexibLc across both den]entia and bub sessions. Dwing this year we bave recruited a fjjrther 8 volunteers, makin8 a total of 10 supporting with the projecl The aim of the Community Outreaeh Se￿1¢e is to bling people togetheT and buiLd strong TeAatioJJthips in and across commuDities by increasing the accessibility of Hospice services to more members of the community. We do this by acting as a conduit to bring the ttvo sid&s together by developitig a two-way referral process betweell the hospite attd local NHS, profrssional and voluntary and community sector community services. This has been a year of developing and tesung ideas, some of which have been very successM from the outsel and some which have (or are) rnotphing to Itieet the needs of the commuwty. HospTce Hub - The Hub has become a meeting place and tbc point of triage into Hospice Services and the wider eommwty network. Sioce slarting the PToje¢E we have engaged witb 97 conununity organisations a¢ross the Chester-Le-Street 8nd tALtharn aru Wc bave done this throuJo distributing leafiets and deiivering prescntations whiclk describe our Conwnunity Outrea¢h Service. The community organisations are a n)ix of NHS, professional setvices or commu￿ty gTOUPS provAdin8 SUPP¢)rt for carers, peopl¢ with life-limiting illness. those who n]8y requiTr counselling, or professional help. We have an initial chat with everyone who comes along and refer to hospicelother Se￿iceS as necessary. Sometimes people are happy just to come to dLe IDJb for coffee and a cbat The hub delivered 45 sessii)t]s this year. A total of 131 people attended the sessions, creating 424 eoDtacts (one contact is one person at one session). We also offer keep iJL touch, caus and our'listeni￿O eav which can support people throug their most difficult times, particularly if they are not able to attend in person. Demenlla Support - is the most su¢cessfjJi strand of tlje project Not only doas it include tbe ￿up Namaste sessions held in Auckland Community Buildin& but also iticludes two Hospice sessiot]s and home visits by volunteers and support telephone ￿ll$. This serv£ce ¢ontinu&s to ￿w. The monthly. singing, musi¢ aud movement ￿0UP is very popular,. participants report that they look forw2Td to it During one quaiter, the Dementia Services team supported 121 people living with Dementia and created 1200 Contacts across the serviGes offetd They also supported 72 dementia carern thith 677 offers of supporL Carer Support - During the year we stopped our Non dementia Ca￿r suppor4 as the same service was being offered by County Carers. We now collcentrdte on Carer training. To daK we have deliv￿ed 5 sessions to 27 people on the subjec t ofAntieipatory Grief. Page 6 ST. CUTHBERT'S HOSPICE DtrRIIAM REPORT OF T￿E TRUSTEES FOR THE YEAR Ef*l)ED 31 MARCH 2024 BereavemeDt Support Providing bereavement Stwrt proven challenging. particul￿lY wbeD attemptinu to offer a support group to itidividuals at varying srages of grief. While the initial vision to develop a peer wport group. we found that many P8rticipants had con]plex needs requiTillU specialised att￿tio￿ tn response, we offered assistallce where possible and referred individuals to other appropriate resources. We aTe ewTently in the process of developiDg a more tailored and supportive model to better address these diverse needs. Our stsff are also undergoing speciaiised ￿leftra]Dillg to enlwice their ability to provide effective supporL Over Ihe past year. we have delivered 41 sessions to 21 individua]4 resulting in 75 contacts. These sessions have provided valuable learAiug experiences d)aE will infotm and improve our approach moving fonvar Everything in Place - despite a slow start due to stsffing changes, one CoU￿e was sucCeSsL￿1Y delivered this year. consisting of 5 ses sions attended by 13 pojticipants. Community F.vents - DLuing thi5 year we have deits'ered 10 COMM￿lty events, usually to pTon]ote the service (alld wider hospice seTvi¢es), in the main th¢ Hub and Everything in Place. We look fonvard to strengthening community support and dehvering services that will promote alld extend the reach of thc Hospice. The cost of providing our Community Outreath pmj¢ct Was £100,606 compared with £72,987 in 2022123. Looking forward We will evaluat¢ the continuing delivery of our pil¢X community outreach proje¢L We will increase the number of volunteers SUPPOTtimg the projext We ￿ill deliver Commutiity engagement events to access potentially hard to reach audience FL¥ANCIAL REVIEW Financial position The Hospice continued to develop serviees despite the finan¢iai consts2ints arising from several yeats of austthity and the ¢hallen8es posed by the cost of living crisis and incTeased energy costs. In the year under review. income decreased by 1.40/9 whilst expenditure incrwed by I1.5Q/o. The decrease in tn¢ome was prkm&ily because of a drop in legacy income which decreased by £475L This loss was offsel however, by a wth in tiading income of £209K The increL8e in expenditure was mainly due to an increase in the nurnber of staff 8nd all increase in direct fimThous Donor Chester-le-streel An Action PartDersbip LWC Xrnas Gift Fuad NEIS Non TecutTing Tl]e National Lottery C¢)n)munity Fund E&Y Strate￿¢ Clintcal Network County Durham Voices Survey Kllow your Neighbourbood The Julia and Hans Rausing T￿￿t (4.433,421) 68,535 (397,179) (3,072) (1,009) (5,537) (7,510) (32) (346) {7241) (85,707) (190) (11,200) (14.143) {ioo,o￿j) 1,972 (1,009) 14,152 (7,510) (32) (346) {7.241) 19,689 85.707 (190) (10,000) 834 1200 14,977 loo.000 226,617 (235.987) (9,370) TOTAL Fuf4DS 4,194J24 (4,669,408) 68,535 (406,549) Comparatives for movement funds Net movement in fijnds Transfers between fimds At 31.3.23 At 1.4.22 UllrestrACted fullds GeD¢ral Fund Fixed Asset Fund MaintenarLce Fund Goal 2 Development Fuud 870,888 3.462,800 165,000 910320 192,786 (110,059) 227,502 62,702 9,000 (288.889) 1,291,176 3,415,443 174.000 621,431 5.409,008 82.727 Rotricted funds Big Lottery Fund County Durham Community Foundation JGW Patterson Foundation Anonymous Donor Chester-le-street Area Action Partnersbip LWC Xrn&s Gift Fulld IPAD for Patients NHS Non recurting 10,315 5,502.050 1347 3,211 13291 18,750 35 597 803 60.107 (2,347) (2202) (13291) 1,009 18,750 32 636 (3) 39 (803) (42,551) (lo￿15) 7.241 99,141 (61,158) (10,315) 27,668 TOTAL FLfNDS 5.508.149 21.569 5,529,718 Page 35 continue