Sue Ryder palliative Care Hub- South Oxfordshire

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question outstanding. At this assessment the rating has changed to good. This meant people were supported and treated with dignity and respect; and involved as partners in their care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

The service had a privacy and dignity policy which placed people at the centre of the assessment, planning and delivery of care. The policy set out how staff should respect people's privacy, dignity, choice, independence, beliefs and personal relationships.

Service users told us staff treated them well, and with dignity and respect. For example, one person told us “Lovely staff who answer all my questions. They did not use medical jargon, they explained it in simple language”. Staff communicated with people and relatives in a calm, respectful and compassionate manner. For example, during a home visit, staff listened to a person’s concerns, explored their wishes and agreed plans of care with the person and their family.

Staff understood and responded to people’s individual needs. Staff considered people's personal, cultural, social, spiritual and religious needs as part of assessments and care planning. For example, before care commenced staff completed a holistic assessment which considered language needs, cultural preferences, spiritual beliefs, family circumstances and any support required from other services.

Staff supported people and families to understand their condition, treatment options and future care wishes. Where additional support was needed, staff worked with other professionals and services to ensure people received appropriate care and support.

People’s confidentiality was respected and protected. The service had processes in place to manage information securely. Although 9 data protection incidents had been reported, records showed that none met the threshold for external escalation. The incidents were investigated and managed appropriately with oversight from a data protection officer. Incidents were identified promptly, immediate action was taken to reduce risk, and learning was shared with staff through reminders, training and improvements to processes.

We scored the service as 3. The evidence showed a good standard. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

People received care that recognised and respected their individual needs, preferences and circumstances. Staff completed holistic assessments that considered people’s physical, emotional, social, cultural, spiritual and communication needs. For example, assessments considered language needs, family circumstances and any barriers that could affect the delivery of care.

The service identified and recorded people’s communication needs at first contact and reviewed these when needs changed. For example, staff could arrange interpreters and provide accessible information and communication support to help people understand information and participate in decisions about their care.

People were supported to access services that met their individual needs. Staff worked with other healthcare professionals and specialist services, including specialist nurses, wellbeing services, counselling and bereavement support. For example, people could be referred to specialist services when their physical, emotional or social needs required additional support.

People’s spiritual needs were also considered as part of their care. Spiritual support was available for people of any faith or belief, as well as those with no religious affiliation. This helped ensure care reflected what was important to each person.

We scored the service as 3. The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

People were supported to make choices about their care and treatment, and staff respected their wishes, preferences and what was important to them. We observed staff discussing treatment options, symptom management and future care wishes with people and those important to them. People using the service were involved in decisions about their care through advance care planning discussions, reviews and multidisciplinary team meetings.

Staff told us they adapted care to meet people's changing needs and preferences. For example, one person was experiencing pain and agitation and was unable to tolerate personal care. Staff recognised that continuing with full personal care at that time would have caused further distress. Essential care was provided, and staff returned later after medication had taken effect. When they returned, the person was more comfortable and able to participate in their care.

Staff respected people's beliefs and values. For example, staff supporting a patient with a strong Catholic faith ensured religious items were treated respectfully and returned to their preferred place following personal care.

Staff supported people to maintain their independence and continue activities that were important to them. For example, one person was supported to attend their appointments at a garden centre, as this was an environment they enjoyed and felt comfortable in. This enabled the patient to remain involved in activities that were meaningful to them.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff identified and responded to changing risks and needs to help keep patients safe and comfortable. Staff told us they had access to specialist support and medical advice when concerns were identified about a person’s condition.For example, nurses could contact doctors to discuss deterioration and symptom management and request a medical review when required. People also had access to a telephone number to request the services they needed, supporting timely access as their needs changed and evolved.

People were regularly discussed at multidisciplinary team meetings. Staff reviewed changes in people’s physical health, emotional wellbeing, safeguarding concerns and family support needs. Actions were agreed and documented to ensure a coordinated response to people's changing needs.

Staff responded appropriately when patients' needs changed. For example, one person became very distressed because they were aware their condition was deteriorating. A senior healthcare assistant spent time listening to the person’s concerns, providing reassurance and allowing them to express their feelings before continuing with their care. Staff told us the person became calmer and more comfortable following this support. Staff signposted people to additional services when needed such as counselling and wellbeing services that were available through the hospice.

We scored the service as 3. The evidence showed a good standard. The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

Systems were in place to support staff development and emotional wellbeing. These included regular check-ins with line managers, access to resilience-based supervision and a 24-hour Employee Assistance Programme. The service recognised the impact of working in emotionally demanding roles and provided access to wellbeing services, debriefs following difficult events and one-to-one support. Mental health first aiders were available, with details accessible on the intranet. Staff told us managers and senior leaders were available to provide additional support when needed.

Some staff described morale as low as a result of recent changes to their role. Several staff told us they felt senior leaders had not always listened to their concerns and reported difficulties communicating with the human resources team.

Leaders acknowledged these concerns and told us they were working to improve communication and staff engagement. For example, senior leaders had met with staff to explain the reasons for the service changes and the impact of the new contractual arrangements. Staff were consulted during changes to working arrangements, and their individual needs and requirements were considered and addressed. Managers told us they continued to listen to staff feedback and recognised that adapting to the new model of care would take time.

The service was taking steps to support staff through the transition, improve morale and embed the new way of working. For example, leaders responded to concerns about workload by proposing a new approach to managing overnight advice calls. This would be piloted for 3 months, with monthly reviews to assess its impact. A flexible working policy was also available to support staff with a better work-life balance.