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Foreword Hospice UK's annual conference is the national hospice and palliative care charity's flagship event, bringing together everyone involved in leading hospice, palliative and end-of-life care for adults, children and young people. In 2018, the conference spanned two days and was held at the International Centre in Telford, Shropshire. Its theme was Transforming Palliative Care and it provided a unique forum for delegates to discuss current and forthcoming issues facing the hospice and palliative care community, and to discover new ways of thinking from outside of the sector. Packed with stimulating plenary and parallel sessions, and opportunities to network with peers and meet major providers of services and products, the conference combined high-level strategic thinking, application into practice and lessons from real-world examples. More than 800 delegates from across the hospice voluntary sector, the NHS and academia attended the conference. They included a wide cross-section of people from the hospice and palliative care sector, such as chief executives, trustees, clinical directors, nurses and doctors, as well as senior staff working in income generation, communication, operations and HR. Leaders of NHS hospices, hospitals and other care providers also attended the event.

Background Inspected in February 2016 the hospice achieved an outstanding rating for Caring and requires improvement for four other key lines of enquiry, Safe, Effective, Responsive and Well-Led, including three breaches of legislation. A new leadership team had been in place for a short while and had already identified an action plan and programme for improvements. Aims There was a lack of audit, quality assurance and governance within the organisation. Reporting of incidents was underpinned by a blame culture which acted as a barrier to incidents being reported, leading to a lack of learning and accountability. Longevity of service amongst some clinical staff created an environment that was resistant to change and a lack of recognising the need to improve and monitor practice. Method A priority was to recruit to key posts including a new Registered Manager and Head of Information and Quality, a team who had the knowledge, skills and ability to engage clinical teams in the change process. Education sessions were carried out to explore how to use incidents as learning experiences to implement changes to practice and improve accountability. A new competency framework was introduced. An audit and research group was set up to facilitate audit becoming routine practice. Quality and data spot checks were carried out monthly. A clinical management team regularly reviewed policies and guidelines in line with legislation and national standards. Improvements were underpinned by improving the patient/carer experience and outcomes: Advance Care Plans, Patient Centred Goals, and Preferred Place of Death. There was investment in workforce wellbeing: clinical supervision, Schwartz Rounds and a representative group. Outcome Inspection in February 2017 achieved ‘Outstanding’ in Caring and Responsive, ‘good’ in Safe, Effective and Well-Led. Overall achieved outstanding, and a delighted workforce. The inspectors noted ‘impressive improvements and a learning culture throughout the hospice’.

Associated stressful life events both within and outside the hospital environment may contribute to the high-risk environment. The cohort studied here was hospitalized for a significant psychiatric problem, a factor which puts them in the high-risk category. When the severe psychiatric diagnosis is combined with a significant stressful life event, the risk of suicide is increased significantly. Language: en

The National Service Framework for Renal Services Part 2 identifies quality requirements for end-of-life care for individuals with kidney failure, recognizing the potential to forge closer relationships between renal and specialist palliative care providers. This article describes a pilot project set up by two Clinical Nurse Specialists, one working in hospice specialist palliative care and the other in renal palliative care within an acute trust. The purpose of the pilot was to work in collaboration to run a streamlined nurse-led clinic that would meet the palliative care needs of chronic kidney disease (CKD) Stage 5 patients and their carers. To achieve this the clinic would have to provide optimal symptom management, empower patients to make their own choices, and support them with advance care planning underpinned by the End of Life Care Strategy. The partnership also aimed to promote service improvement and practice development using transference of knowledge, skills, and expertise. Initial informal feedback, including a very small patient survey, suggests that the clinic was well received by patients, carers, and other health professionals. The clinic is ongoing and deserves more formal evaluation to encourage future service development.

Background Advance Care Planning (ACP) is a voluntary process of discussion about future care between an individual and their care providers and is recommended as best practice in end of life care. Hospice in the Weald (HitW) routinely documents patients9 ACP in the patient record. This audit was carried out to ascertain what impact this information had on the patients9 end of life care. Aims To identify how many deceased patients had ACP conversations clearly documented in their record To explore the content of the information in the notes in a 10% random sample To look at place of death for these patients and compare with those who didn9t have ACP notes Method A retrospective audit was performed looking at patients who died between 1/8/2012–29/2/2013. A 10% random sample was identified, of whom half had ACP clearly documented. The notes were read and salient information recorded. Results 439 patients died during the 7 month period of whom 51% had an identifiable ACP conversation recorded in their notes. 44 notes were looked at and there was a marked difference between the place of death for those with documented ACP and those without (Home 37% vs 22% and Hospital 4% vs 19%). There were many instances where although ACP conversations were taking place they were not recorded in one location and not updated and therefore were not easily accessible to all staff. Conclusions This audit confirms that well documented ACP conversations do impact on place of death but that even within a specialised setting, it can be difficult to identify significant ACP discussions and for all staff to be easily aware of them. This has implications for recording and sharing this information between organisations which is recommended best practice. Changes to our recording processes are now in place in an attempt to improve this for the future.

Two peach cultivars (Flordaking & Junegold) were planted in wheel-spoke design under a center pivot irrigation system. Main plots were sprays (Blast, Cheek, & Piggy-back) and cultivars. Sub-plots were training systems (Inside, Outside, & Standard). Sub-sub-plots were tree areas. Four rows were planted with two Inside rows and two Outside rows. Middle two rows of the standard plots were harvested. Intra-row spacing increased the further they were from the center. All trees harvested in 1990, standard plots were harvested every year, and Inside/Outside were harvested in alternate years. Most sources of variation in the model failed to be homogeneous among the 3 years. Since the number of trees harvested each year varied, all mean comparisons were done using the unequal N - unequal variance t-test.