Following a detailed consultation with our Medical Director, Senior Management Team and patients and their relatives we have identified a need to recruit the services of a highly qualified and experienced Clinical Psychologist on a three day a week basis. The National Institute for Clinical Excellence (NICE) found that for cancer patients that “around the time of a diagnosis of cancer, approximately half of the all patients experience levels of anxiety and depression severe enough to affect their quality of life adversely. About one quarter continue to be so affected during the following six months. Among those who experience recurrence of disease, the prevalence of anxiety and depression rises to 50% and remains at this level throughout the course of advanced illness. In the year following diagnosis, around one in ten patients will experience symptoms severe enough to warrant intervention by specialist psychological/psychiatric services. Such symptoms can also be seen in 10-15% of patients with advanced disease”. In addition to the information from NICE we are aware of a recent survey, which was conducted for the journal “Palliative Medicine” which found that 58% of patients cited depression and fear above pain as being the worst thing about their terminal illness. The National Institute for Clinical Excellence highlights four levels of psychological care, which should be available within an organisation providing care for adults with cancer. This includes a hospice . • Level 1 involves all staff directly responsible for patient care and is focused on general emotional care. • Level 2 focuses on screening for psychological distress at key points within the patient pathway. These are: around the time of diagnosis; during treatment episodes; as treatment ends and at the time of recurrence. • Level 3 focuses on ensuring that professionals can differentiate between moderate and severe levels of psychological need and can refer those with severe needs to mental health specialists. • Level 4 this is the highest level of psychological care and is achieved when a service has the appropriate mental health specialists who are able to assess complex psychological problems including severe affective disorders and psychotic illness. Currently here at Phyllis Tuckwell Hospice we offer support up to level 3. We currently lack the resources to provide the highest level of psychological care, level 4 care, to patients and their loved ones. This means that we cannot provide the full level of clinical support needed to care for a patient in severe psychological distress and as a result may use sedative drugs or try to access outside professional support with the problems of limited availability and response time. Our aim therefore is to seek funding to employ a Clinical Psychologist who can work with patients and carers who are experiencing severe psychological distress to provide solution focused psychological therapies to help the patient address their issues and develop coping strategies which will aid their psychological well-being. The Clinical Psychologist will either visit patients by their bedside within the Hospice, or will visit patients being cared for by us at home. For relatives, the Clinical Psychologist will see people in a private room made available to the service within the Hospice or where necessary within their own home. The Clinical Psychologist will also work with our Medical Team and Patient and Family Support Team on a one day a week basis. The Clinical Psychologist will provide support and training to medical staff that provide level 1 and 2 care to patients and will work collaboratively with our teams who provide level 3 care. The Clinical Psychologist will provide support and training to help staff that are working within levels 1 and 2 to gain the appropriate skills and experience to elevate the level of psychological care that they can give to above that which they are currently providing. This will increase the overall level of skill with our medical team, in relation to psychological care. In turn this will enable us to deliver a better quality of care to patients and their families and to be become better equipped at early intervention in relation to psychological risk factors. In addition to this the Clinical Psychologist will provide clinical supervision to medical staff and volunteers who are working within the Hospice. The National Institute for Clinical Excellence recognises “Burn-Out” as a real risk to front-line staff working within a difficult and emotionally challenging healthcare environment. Therefore the Clinical Psychologist will work with Hospice staff to ensure that their psychological needs are being met and the appropriate support can be given if a member of staff is exhibiting signs of psychological distress. This practice will not only ensure that staff receive the appropriate level of clinical support at an earlier stage, but it will also save the Hospice in terms of funding as at present, clinical supervision for staff is “brought-in” from outside. Our aim is to secure funding to run this post for an initial period of two years. We will implement vigorous systems to evaluate the effectiveness of the post. Each patient or relative who benefits directly from the service will be asked to rate the service and its impact upon him or her. As many of the patients who use the service are extremely unwell we will simply ask them to score aspects of the work from one to ten, as it would be impractical and un-fair to ask them to fill in complicated evaluation forms. These ratings will be assessed on a quarterly basis to ensure that the work is having a positive impact. In addition at the end of each year an Impact Report will be commissioned which will look at the whole project and measure its performance against pre-set targets. The Impact Report will record successes as well as areas where performance could be improved. These reports will be shared amongst the Hospice’s Senior Management Team, key stakeholders and funding partners. The Year One Impact Report will also help the Hospice decide how to support the work beyond the initial two year funding period. We are very excited about the prospect of bringing a Clinical Psychologist into the Phyllis Tuckwell Hospice multidisciplinary team. Not only will this service bring tremendous benefit to patients, relatives and our dedicated Medical and Family Service teams but the appointment of the Clinical Psychologist will also help our Hospice meet all four standards required by the National Institute for Clinical Excellence (NICE) that we aspire to. As a Specialist Palliative Care Organisation we are constantly reviewing and trying to raise our standards of care. Currently we provide an excellent range of services to meet three of the four standards, these are: 1. Physical 2. Social 3. Spiritual The appointment of a Clinical Psychologist will mean that we meet the forth standard; Psychological. By employing a Clinical Psychologist we will be able respond quickly to patients and carers with high levels of psychological distress. This fits into the guidelines laid down by the National Institute for Clinical Excellence which states that there is a need to improve access for patients and carers to psychological services across all organisations that care for people with cancer. It is important that we employ a qualified and experienced individual who is comfortable working in the highly emotional Hospice environment. The Guidelines from the Institute for Clinical Excellence state that services like ours needs to have access to a Clinical Psychologist qualified to level 5. This is because the level of skill needed to deal with complex and urgent cases which may also require the involvement and coordination of other health care professionals is very high. Therefore, the total cost of running this post for two years is £79,974 . This cost includes salary and on-costs such as telephone, travel and stationery.