End of Life Care : Aneurin Bevan Service Specification

End of Life Care Companion Volunteer Service

Service Specification

Introduction

The Aneurin Bevan University Health Board has secured funding to develop and pilot an End of Life Care Companion Volunteer Service. This service will be available to those patients who are most at risk of dying alone i.e. a patient with limited or no family support/visits. It will also be available to families/carers who require additional support at this distressing time.

It is recognised that although some people may choose to die in hospital, for others this may not be the place of choice but circumstances may prevent them dying in their preferred location. Patients in hospital may die alone or have minimal contact with loved ones at the end of their life. Some patients may have family, friends or carer’s present but often they too can feel overwhelmed, anxious and isolated.

For the purpose of the pilot, the service will operate across 3 distinct areas at the Royal Gwent Hospital, namely Care of the Elderly, Respiratory and Gastroenterology wards. These sites and roll out of the service will be subject to review as the pilot progresses.

Service Description

The key aims of the End of Life Care Companion Volunteer Service are to provide emotional and practical support, companionship, advocacy, signposting to other relevant services and the alleviation of social isolation often felt by the patient and their family and friends who may be supporting them.

Companions can provide short term respite care for families. They will provide an opportunity for patients and families to share their stories, worries and concerns by listening and comforting them at this difficult and personal time.

Additionally the companion service will work very closely with the Aneurin Bevan University Health Board Bereavement Services. Companions will provide post death support by contacting the bereaved after death and signposting to relevant community services if requested or desired.

Principle Functions of the Service

Benefits to Patients

The benefits that this companion service will bring to people at the end of their lives who have been admitted to an acute care setting to die will include:

• Individual support for patients
• Provision of companionship during the dying phase for people without visitors ∙ Practical advice relating to the hospital environment and the dying process ∙ Support with practical tasks such as requesting a review by the clinical team ∙ Facilitating and supporting difficult conversations lead by health professionals ∙ Allowing people the opportunity to talk about what matters to them

Benefits to Relatives, Friends and/or Carers

The benefits that this companion service will bring to relatives, friends and/or carers people at the end of their lives who have been admitted to an acute care setting to die will include:

• Advocacy for families, friends/carers who might find it difficult to understand what is happening
• Assurance that a Companion will sit with their loved one if they are unable to visit
• Practical advice
• Facilitating discussions with clinical teams
• Signposting to post death support
• Allowing families/carers an opportunity to talk about what matters to them

Benefits to Staff

For healthcare professionals on busy wards Companions provide another support service that can be offered, enhancing the end of life care that is being provided.

• Access to a Companion Volunteer to support patients that the clinical teams identify as having limited support
• Assurance that patients/relatives/carers have access to additional support to guide them through the dying process
• Assurance of improved signposting for relatives/carers to support services post death
• Allowing staff an opportunity to talk about what matters to them when caring for patients at the end of their life

Roles and Responsibilities

Companion Volunteer: Duties

• To establish and build a positive relationships with patients, relatives, carers and staff
• Undertake dedicated Companion visits on the designated wards to provide comfort and support to patients/relatives/carers at the end of life
• Provide a listening ear gathering important stories and feedback to inform improved service delivery and meaningful end of life care experience
• To signpost relatives/carers/friends to post bereavement support
• To provide regular updates of Companion volunteering activity during peer support sessions
• To gather and share patient, relative, carer and staff stories
• To always adhere to the lone worker policy and buddy systems
• To attend training relevant to the Companion volunteering role
• To observe organisational policies and procedures and escalate concerns
• To attend supervision/peer support as required

Person Specification

The Companion Volunteer must possess the following skills and be willing to do the following:

• Be positive, friendly and understanding and have a ‘can do’ attitude ∙ Able to maintain boundaries
• Demonstrate a very caring and compassionate nature
• Be non-judgemental and respectful
• Possess good listening and communication skills
• Be reliable and punctual
• Maintain confidentiality
• Be willing to undertake training
• Be able to work as part of a team
• To give an average of 12 hours per month to be able to carry out the Companion role
• To learn new skills
• To work with adult individuals of all ages on the identified wards ∙ To provide confidential feedback with the aim of improving the end of life care experiences of patients and their relatives
• Understanding of the importance of confidentiality and following procedures Companion Volunteer Co-ordinator: Duties
• The Companion Volunteer Co-ordinator will work alongside the Associate Director of Nursing and the Project Manager and will:
• Develop operating policies and procedures for the Companion Volunteer Service in an acute setting in conjunction with the hospital wards and Person Centred Care Team
• Promote the service across hospital teams
• Recruit volunteers
• Deliver an agreed volunteer training programme
• Secure and manage referral processes and systems ensuring the timely allocation of Companion Volunteers
• Supervise the volunteers
• Liaise with the hospital staff and Person Centred Care Team during operating hours and resolve any issues
• Set up the evaluation systems, including collecting baseline survey data ∙ Research and contribute to an evaluation report
• Measure patient and carer satisfaction relating to their end of life care experience in the hospital setting. This will include the need to gather case studies, undertake interviews and questionnaires of the volunteers, families and hospital staff
• Measure perception and confidence amongst health professionals in using the companion service. This will include interviewing and sending questionnaires to hospital staff.

Person Centred Care Project Manager

The Person Centred Care Project Manager will:

• Provide day to day direct line management of the Companion Volunteer Co Ordinator
• Oversee the recruitment process of Volunteers ensuring NHS systems and processes are followed
• Take responsibility for completing and signing off DBS and references checks ∙ Issue volunteer contracts
• Ensure ongoing supervision of the Companion Volunteer Co-ordinator and volunteers; this will include induction and training.
• Ensure robust performance management of volunteers in collaboration with Marie Curie Companion Coordinator.
• To provide office space: office equipment: IT and photocopying facilities for the Marie Curie Companion Coordinator
• To ensure provision and access, where necessary, to meeting rooms as requested
• To provide information, assistance and cooperation in support of the service.

Associate Director of Nursing

The Associate Director of Nursing Person Centred Care Team will be responsible for: -

• Overall management of the project
• The employment and line management of the Volunteer Service Coordinator ∙ The provision of senior management representation at strategic governance meetings
• The provision of evaluation guidance in relation to the service ∙ Sharing knowledge and experience of end of life care from a national perspective
• Working in collaboration at all times with the Aneurin Bevan University Health Board Executive Team and key Committees/Boards including the Patient Experience Committee and End of Life Care Board
• The provision of logistical and administration support to the Companion Service Coordinator. Administration support will be provided from the Person Centred Care Team
• The production of evaluation reports as required by the Service funders.

Recruiting Volunteers

Volunteers will be recruited in accordance with ABUHB’s Volunteering Policy and the Companion Volunteers Service Specification.

Induction

Induction will commence 1 week before the volunteer takes up post. The induction will include:

• Information about the organisation
• Information about the Companion service - background of scheme, client group, structure and management
• Volunteer role and responsibilities which will include role description, expectations of volunteers, code of conduct, boundaries etc.
• Policies and procedures - volunteers will be provided with the relevant policies and procedures
• Support and supervision - volunteers will be advised of who they will report to, how often supervision will take place, training, how to claim expenses etc.
• Health and Safety - which will include personal safety
• Introduction to staff members/other volunteers

Training

• Companion volunteers will be provided with a training programme. Training will include:
• Communication
• End of Life Care Experience
• Pastoral support
• Lone working
• Escalating concerns
• Protection of Vulnerable Adults
• Maintaining boundaries
• Dementia Friends
• Welsh Language Active Offer
• Equality and Diversity
• Deprivation of Liberties Safeguards (DoLS)
• General Data Protection Regulations (GDPR)

Support and Supervision

All Aneurin Bevan University Health Board Volunteers will be offered 1:1 supervision on a 6 weekly basis and group supervision every 2 months. This will be undertaken by The Project manager and Companion Service Co-ordinator. Additionally, Volunteers are able to contact the Associate Director of Nursing at any time in between arranged supervision.

• There will be regular communication with all Companion volunteers including face to face, by telephone, email and at agreed meetings.
• Supervision will enable all involved to:
• Monitor and evaluate duties and performance
• Improve confidence in the role
• Recognise and deal with issues
• Identify training needs
• Provide a framework for agreement on change
• Provide a framework for discussion about the role and responsibilities ∙ Provide a framework to share perceptions on how the work is progressing and identify what is going well and what may need to change
• Consider the outcomes, outputs and impacts of the service Travel Expenses
• Volunteer travel expenses will be reimbursed on receipt of a valid claim form

Companion Service Hours of Operation

The Companion service will operate between 9am and 8pm on weekdays and at weekends. The service is expected to support at least 50 patients in the first year.

Referrals

The ward staff will identify patients and families on within the 3 designated ward areas and complete the referral form. Initial discussions can be held with the Companion Volunteer Co-ordinator to ensure there is no delay in Companion Volunteer Support whilst the referral is being completed.

In addition, patients and their families may self-refer.

Response Time and Detail of Prioritisation

The aim is for received referrals to be actioned on the same day they are received and that [patients, families, carers will be supported on the day of referral. This will be dependent on the availability of the volunteers and may be slightly longer during the initial start-up of the service.

Service Base

For the purpose of the pilot, the service is delivered from the Royal Gwent Hospital, Newport where the Companion Service Coordinator will be based.

Training and Development

Ward staff will be offered training to understand how the service will run and to gain a clear perspective on the role of the Co-ordinator and Companion Volunteers. It is expected that the Divisional Nurses/General Managers and Ward Managers will release staff to attend this training.

Volunteers will be trained in accordance with the Aneurin Bevan University Health Board Volunteer Training programme.

Population

For the purpose of the pilot, this service will be provided for dying Patients, their families and carers within the 3 identified service areas at the Royal Gwent Hospital (Care of the Elderly, Respiratory and Gastroenterology). Roll out to other areas will be subject to review and recruitment/availability of Companion Volunteers

Inclusion Criteria

The service will be available to all patients over the age of 18 in the last days or hours of life who are receiving care on the 3 service areas identified above. It will also be available to the family/carers of patients on these areas.

Exclusion Criteria

During the pilot, the service will not be available to patients being treated as out patients, community patients or patients less than 18 years of age including carers under 18 unless accompanied by an adult.

Monitoring and Evaluation

Monitoring of activity will be undertaken through the monthly Companion Volunteer Steering Group meetings. Progress on the initiative will be reported through ABUHB’s Patient Experience Committee, End of Life Care Board and through to the Funders via Helpforce.

• Annual monitoring information will include:
• Number of referrals to the Service (patients, families and carers) ∙ Number of visits/people seen (patients, relatives, carers)
• Signposting activity
• Number of volunteers recruited
• Number of training sessions delivered for volunteers
• Equality/diversity monitoring
• Feedback from service users, volunteers and referrers/staff

An annual evaluation of the service will be undertaken and reported through agreed committees. Evaluation will include using the outcome information and other information gathered to make judgements about the Companion service and its outcomes and will include:

• Whether the service has been successful in achieving its objectives ∙ Whether there have been any unexpected outcomes
• The impact of the scheme
• Does the evidence indicate that there is still a need for the service, or even a need for expansion?
• Are more resources needed to deliver the service?

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