ACCORD Hospice: readiness for rainy day scenario pays off

Jacki Smart, recently appointed Chief Executive of ACCORD Hospice in Paisley, Scotland shares her thoughts on adapting services, community support and financial management through the Covid-19 crisis.

ACCORD Hospice provides the communities of Renfrewshire and East Renfrewshire with high-quality specialist palliative and end of life care. The charity offers a range of services which include an Inpatient Unit, day services, community nursing support as well as guidance with social and financial support.

“Our priority is to help people live in the place they want to be at the end of their lives, ensuring they experience the best end of life possible,” says Chief Executive Jacki Smart. 

Jacki explains that, because ACCORD received a grant to refurbish its inpatient unit last year, the charity now has a state-of-the-art infrastructure enabling the team to better manage the impact of Covid-19. The unit now consists of single-occupancy rooms with patios that allow for easier access and care.

However, the hospice’s occupancy is currently lower than usual as families are more likely to be at home to support the needs of their loved one. “People are also possibly scared of such hospital settings at this time,” says Jacki. “Fortunately for ACCORD, we haven’t had any positive Covid-19 cases.” 

As a result of the pandemic and lockdown, ACCORD has adapted some of its services considerably, such as the community nursing service and day therapy unit. The charity has also temporarily joined forces with St Vincent’s Hospice charity to combine both hospice inpatient units onto one site at ACCORD to support flexibility and sustainable staffing.

“One of our biggest challenges is to support people at home while also protecting our staff and the community.” To help manage this challenge the hospice has developed a robust risk assessment tool, ensuring patient’s needs are met utilizing various support methods. For example, if someone’s needs are greater than the risk of transmission of Covid-19, the team will still visit them at home while doing everything possible to reduce any risk – including wearing personal protective equipment and practicing good hygiene.

Jacki says that although the charity’s face-to-face visits have reduced significantly (to something around one in five of the people they would normally see) the team is still talking to large numbers of patients and their families every week by telephone, Skype or Facetime. “Just staying connected and letting them know that we’re still here if they need us seems to be a big help for many people.”

ACCORD’s day therapy unit, which people attend not just for support but also to socialise, has had to physically close its doors. However the team has recreated these services into a virtual setting, allowing service users to still ‘get together’ as they would at the unit.

A culture of caring

Jacki explains that apart from a few key senior team members and the catering, housekeeping and maintenance teams, everyone is working from home. The senior management team strives to be very accessible, and uses Zoom for weekly meetings. They update the staff on the charity’s financial position, Covid-19, and any changes to guidance, as well as checking to see how everyone is coping during these strange times.

“We also play some light-hearted games,” says Jacki. “The care and compassion attached to the work my team does also applies to how they treat each other. It’s a lovely place to work.” For Jacki, it’s really important that they retain this caring culture through this difficult time. This is also evident in the overall governance of ACCORD as it continues to hold its monthly management committee meetings and quarterly board meetings, albeit remotely. 

ACCORD’s Board of Directors remains very active with a good mix of financial, medical and legal expertise and support throughout this period. Jacki, who was previously a trustee and has only been Chief Executive for 12 weeks, is grateful for their involvement and positive support. “I feel safe as a new Chief Executive, and I feel very much supported to make the more difficult decisions.” 

Funding challenges

“When Covid-19 hit one of our main concerns was to understand our cash flow position and what our situation would be if we couldn’t generate any income.” ACCORD’s finance team estimates that the charity is losing around £60,000-£80,000 in income each month, which will obviously make it harder to cover all running costs. However Jacki explains that the charity’s current financial position means it should have the ability to sustain current services for most of the year.

ACCORD has a good relationship with its local Health and Social Care Partnership, which provides funding that covers 42% of the hospice’s running costs. The remaining 58% is usually covered by income generated by the charity’s retail services, lottery, fundraising activities and various donations. At this moment however, the shops are currently closed and most fundraising efforts have been negatively impacted by the lockdown.

Fortunately however Jacki says that donations are still coming in and the fundraising team has been agile in finding new ways to host virtual fundraising activities. “ACCORD is a local treasure,” says Jacki. “It’s well known and loved by the community, and well supported by families who’ve used the services.” For example, a daughter recently donated the money left in her late mother’s bank account to the hospice.

ACCORD has also used the Government’s job retention scheme to support its furloughed shop staff and drivers, and has applied to a number of local and government schemes and grants that are still available. Recently the hospice applied for National Lottery funding which was successfully secured. Such funding has been used to assist ACCORD’s Education team to develop outreach support and education for care homes in our area who are sustaining care for an increased number patients at end of life due to the impact of Covid-19.

Jacki welcomes the UK Chancellor’s recent announcement regarding additional hospice funding. The Cabinet Secretary for Health for Scotland has now clarified the details of the package and Jacki expects this to be incredibly helpful in allowing ACCORD to ensure ‘business as usual’ for all the patients and families we support, as well as protecting the financial stability of our organization moving forward. 

Prepared for a rainy day

ACCORD has a low to medium risk investment portfolio with Rathbones and doesn’t plan to change its investment strategy for the foreseeable future. As with all investments it has recently taken a significant knock but Jacki says she trusts Rathbones to steer the right course. “We’ve been with them a long time and their advice is to stay in this for the long haul.”

ACCORD’s finance director speaks regularly to the Rathbones team, which has set up a virtual portal that gives the charity access to its daily investment position which Jacki says is helpful. “They are very supportive and always available.”

If the charity does have to realise some of it investments further down the line, it will be because it has no other option. Jacki reiterates that ACCORD’s priority is to continue to provide excellent service for palliative and end of life care, with our reserves there to ensure it can do that. “We have always aimed to protect ourselves with good reserves and have always had ‘rainy day money’ set aside, and if this isn’t a rainy day, what is?”

Looking ahead

While the future is still uncertain, Jacki says there are three things that will allow ACCORD to continue doing what it does best.

Firstly the charity will be better prepared to respond to difficulties now and in the future. From being a fairly traditional organisation, it has had to quickly adapt agile and virtual practices. “Covid-19 has forced us to develop new ways of working, which the staff are enjoying. We’ll keep these in our toolbox going forward.”

The charity’s prudent financial management has been instrumental in helping it manage through the pandemic crisis. “My advice for other charities is to get yourself into a position where you’re prepared for the rainy days. Such preparation has lets me reassure our governing bodies, service users, staff and the community that we’re okay, and can continue to provide our services, which is really what it’s all about.” 

Finally Jacki believes relationships are key within this current situation and moving forward, acknowledging ACCORD’s relationships with their community has helped keep them afloat. “We have been overwhelmed by both the financial and practical support offered by our community to achieve our goals. Thank you.”