Willow Burn Also known as Maiden Law Hospital, Maiden Law Hospital,DH7 0QS

On this page

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

We rated caring as good. This meant people were truly respected and valued as individuals; and empowered as partners in their care in an exceptional service.

Patients received care and support that was exceptionally compassionate and kind. Staff cared for patients and each other in a way that exceeded expectations and fully respected their privacy and dignity. Staff demonstrated genuine empathy for the patients cared for and for their loved ones, and were able to act creatively to uphold these rights, even in challenging situations. The embedded culture of kindness and respect extended to colleagues as they were treated in the same manner.

The service helped patients to understand their rights and express their views so that staff and managers and staff at all levels understood their views, preferences, wishes and choices. Staff had a strong understanding of patients’ human rights to dignity and respect and were able to act creatively to uphold these rights, even in challenging situations.

Staff went to great lengths to make sure that patients’ needs, views, wishes and comfort were their utmost priority. They went above and beyond to anticipate patients' needs and took steps to ensure preventable discomfort, concern, and distress for patients.

Staff were able to anticipate when someone needed urgent end of life care or support and offered this immediately, using the most up to date tools as required.

At our last inspection we rated this key question good. At this assessment, the rating has changed to outstanding.

This service scored 85 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service was exceptional at treating people with kindness, empathy and compassion and in how they respected people’s privacy and dignity. Staff always treated colleagues from other organisations with kindness and respect.

Staff attitudes and behaviours when interacting with patients showed that they were discreet, respectful and responsive, providing patients with help, emotional support and advice at the time they needed it.

Patients said staff treated them well and behaved appropriately towards them. Staff provided care and support that was exceptionally compassionate and kind. All people we spoke with said they and their loved ones were treated with kindness, compassion and dignity in their day-to-day care and support. Leaders and staff were motivated and inspired to offer care for patients with kindness and compassion.

We saw staff did not rush patients or their loved ones and listened to them and gave them comfort and reassurance. All people we spoke with agreed staff were kind and compassionate. The partner of a patient wrote in a card to staff “Thank you for the special care, love and affection you gave during their 3-week stay in Willow Burn. You are all some of the kindest people I have ever met in my life”.

The hospice leaders promoted and supported its staff to ensure dignity and privacy were central to the care they provided. Staff told us, and we observed, staff cared for patients and each other in a way that exceeded expectations and fully respected their privacy and dignity. At every opportunity, doors were closed according to patients’ wishes. Staff would close these, curtains were drawn, and blinds were closed on patio doors when they provided intimate care. We observed staff greeted visitors and checked the patient’s privacy needs if requested. Staff communicated with each other and with families if patients did not wish to be disturbed as they were resting. Patients told us staff closed doors to give them privacy when they were distressed.

Staff demonstrated genuine empathy for the patients they cared for. Patients felt staff listened to them and communicated with them appropriately, in a way they understood.

Patients felt staff knew and understood them, including their preferences and wishes. Information about patient’s wishes were recorded. Managers told us they supported and had facilities for deceased patients to remain in their room for a limited amount of time to enable their loved ones to come and say their goodbyes properly before they were taken to the funeral directors.

Patients said staff responded to their needs quickly and efficiently, especially if they were in pain, discomfort, or distress. One patient told us “the nurse will come and stay with me if I’m feeling panicky”. Relatives told us: “Staff come straight away, or they just seem to know when we need them” and “we know there are other patients here but the staff make us feel like we are the only ones”.

Patients were assured information about them was treated confidentially and they knew staff respected their privacy. Staff followed policy to keep patient care and treatment confidential. The service had an information governance policy and staff were compliant with it. Conversations between staff and patients were kept private and sensitive information was never shared in the presence of those not authorised to hear it. Patients and their loved ones were able to share their fears for the future and were confident their concerns would not be shared with their loved ones.

The service treated people as individuals and was exceptional in how they made sure people’s care, support and treatment met people’s needs and preferences. The service took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and so on.

Patients’ personal, cultural, social and religious needs were understood and met.

The hospice and its staff had a strong patient centred culture with patients’ individual needs and preferences understood and reflected in their care. Staff and leaders acted as role models and encouraged each other to think and act creatively to meet the needs of patients’, families, and their colleagues. Staff had a strong understanding of patients’ human rights to dignity and respect and were able to act uphold these rights, even in challenging situations. Staff made adjustments for families when it was necessary to visit out of hours and there was a clear policy and safe process for visiting at night.

Information about what was important to the person were clearly identified. This included information such as how to share bad news with their loved ones and their interests.

Staff supported patients to take part in activities they had special interests in such as sitting in the garden. There were many examples of caring and compassionate staff supporting patients for example pets could visit their owners. Staff would move an additional bed into a room so that partners could be together. There was a bed settee in the family room for overnight stays for a relative when they recognised they were exhausted.

Staff supported patients to enjoy “pamper” sessions in the “spa” bath with spa lighting, in a jacuzzi bath, and they could enjoy their favourite music. Staff left a call bell within easy reach so the patient could enjoy their privacy but easily call for help or when they felt ready to leave the bath.

Patients had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for allergies and intolerances. Staff, including the chef, would listen to patients’ dietary needs and requirements and readily arranged for special meals, afternoon tea and sparkling wine for special occasions and arranged for takeaways to be brought in when requested. Whatever patients identified was important to them staff would endeavour to enable them to experience it. Staff enabled a patient who was nearing end of life and had a young family to enjoy an early Christmas in November. Staff had decorated the family room, arranged for Santa Claus to visit, provided presents and a Christmas meal for the family. Staff took photographs so the patient could remember the day after the children had left.

Staff arranged for a patient’s friends to come for an afternoon visit. They encouraged the visitors to bring wine and provided glasses and cakes.

Staff understood and respected the personal, cultural, social and religious needs of patients and how they may relate to care needs. The service respected diversity. On admission staff completed a spiritual core care plan with patients and staff ensured that patients had access to appropriate spiritual support. A patient had requested that she would wear her wedding sari following her death. She taught the staff how to dress her and apply her make up and staff were able to grant her wishes.

We met the hospice chaplain who was available onsite and on call to provide spiritual and bereavement support. The chaplain provided spiritual care to patients of all faiths and none, and facilitated faith leaders to come and meet the patient’s spiritual and religious needs. The hospice had a quiet room for patients to use for reflection and as a space to meet their cultural and spiritual needs, regardless of faith and there were additional multi faith items available for use at any time.

Patients’ communication needs were met. Managers ensured that staff and patients had easy access to people and tools to support clear communication. Managers ensured that staff could access translators in various languages including British Sign Language. This enabled patients to engage in their care, treatment and support. The hospice could provide information leaflets in various formats including large print, audio, Braille, an alternative format, or in another language. There were instructions for staff on how to access these services.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and comment on care. These were discussed as part of the admission process, but also with the family liaison officer, managers, nurses and doctors throughout the patient’s stay and flexing to meet specific or specialist needs.

Willow Burn had a Carers Network which provided a forum to support carers and loved ones. Carers were invited to wellbeing sessions where they could meet other families with similar needs. Many of the hospice volunteers and some staff had lost relatives who had been cared for at Willow Burn.

Staff treated patients as individuals, considering any relevant protected equality characteristics. Staff respected the individual needs of each patient and showed understanding and a non-judgmental attitude when caring for or discussing patients with mental health needs. Staff received training in equality and diversity, so they understood, valued, and celebrated difference.

Staff received training on the ethos of the service so they had a clear focus on enhancing the lives of patients with a terminal illness to provide them with more quality time with their loved ones, and this meant finding out what mattered to them to promote their choices and give them control over what their care should look like.

The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

The hospice admission process was centred around helping patients to understand their rights and express their views so that staff and managers at all levels understood their views, preferences, wishes and choices. Patients were supported to have choice and control over their care and to make decisions about their care, treatment and wellbeing.

Staff used the advanced care planning process to talk through and document patient choices, their treatment, and symptom management. Staff used advanced care planning to help and enable patients to make choices on their stay and, where possible, discharge home or to another service. One patient wrote “I’m in awe of your dedication to making a difference to patients here. It’s made the difference to allow me to go home when we didn’t think it would be possible”.

All bedrooms had direct access to their own patio area with additional accessible access to a large communal garden with several seating areas to enable people choice to be outside if they wished.

Service user evaluation results showed 100% of patients and family members who responded felt extremely satisfied with overall communication and a family we spoke with said they felt they were involved in and had a choice about every part of the patient’s care from the beginning.

Specific feedback collated by the hospice, included “I wanted to express my gratitude for the exceptional care and compassion you provided to my (relative) during her time with you. Your team went above and beyond to ensure her comfort, dignity and well-being and it meant the world to our family. We are truly grateful for the kindness and professionalism shown by everyone involved. Your dedication to provide such a warm and caring environment brought us peace in a difficult time. Please know that your efforts made a profound difference and we will forever be thankful for all you did for her”. Another family wrote “All of our wishes are considered and staff do all they can to help (the patient) have what they want”.

Patients were supported to maintain their relationships and networks when being cared for. Friends and family were able to visit when the individual wanted them to and there were arrangements in place for overnight stays when required. Patients said staff always made them welcome.

There was a clear focus throughout the hospice on maintaining independence. Community support services were focused on maintaining health, wellbeing and daily living for as long as possible, to ensure the best possible quality of life. Equipment was available to promote patients’ independence, choice and control. A manager told us that when caring for a younger adult patient, staff, as always, had asked about their personal and cultural needs, hobbies and interests. The patient had requested to wear a hospital style gown to help manage their personal care needs. Following their conversation, a nurse had gone shopping for some fabric whilst off-duty and had sewn a gown with a “goth” motif. The patient had been overwhelmed with gratitude and managers praised the nurse for their efforts over and above what was expected.

The service listened to and understood people’s needs, views and wishes. Staff always responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff were aware of and dealt with any specific risk issues, such as falls or pressure ulcers and care planned for these accordingly. Staff assessed all aspects of the patient’s condition and existing treatment from the original referral and conversations with referring staff. Any risks were identified through thorough risk assessments prior to admission, and these were assessed again and documented on admission. Staff identified and responded to changing risks to patients on a weekly basis or sooner as necessary. However, 2 patients had fallen when their independence and mobility needs had changed, and staff identified they should have reviewed their risk assessments sooner. These incidents were reported, reviewed and learning was identified and shared to ensure all staff took the responsibility to proactively review risk assessments as patients’ needs and behaviours changed.

Staff went to great lengths to make sure patients’ needs, views, wishes and comfort were their utmost priority. They went above and beyond to anticipate patients’ needs and took steps to ensure preventable discomfort, concern or distress for patients. We observed staff communicating and engaging with patients in discussions about their immediate needs. This included asking about their symptoms as well as what was most important to them at that point in time. Regularly checking how they and their loved ones were and asking about their pain, potential side effects such as nausea to ensure timely escalation would be made and ensuring they had the food and drink they wanted.

The service user evaluations identified 100% of people who contributed an opinion were extremely satisfied with the care provided.

For those patients who wanted additional or alternative management of pain, anxiety or distress, staff arranged for patients and loved ones to receive alternative therapies such as massage and aromatherapy which were available within the hospice.

Patients said staff always made them feel welcome and told us their needs were met. We observed staff on the inpatient ward responding quickly to patients’ needs. One patient told us ‘’The staff make sure I am ok, they help me through the difficult times.”

Staff were able to anticipate when someone needed urgent care or were actively dying to provide timely and appropriate support. Managers and staff had worked hard to identify when patients were in their last hours of life and took appropriate action such as alerting loved ones and be with the person if they wished when they died.

The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

The embedded culture of kindness and respect extended to staff and colleagues. The hospice recognised and met the wellbeing needs of staff, and staff felt patients received safe, effective and person-centred care as a direct result. There were facilities for safe working in a pleasant and comfortable environment, rest areas and regular scheduled rest breaks. All staff we spoke with, from all staff roles said they loved working at the hospice, and it was a privilege to care for their patients.

Patients benefited from staff who had regular opportunities to provide feedback, raise concerns and suggest ways to improve the service or staff experiences. If necessary, leaders provided a timely and considered response. The hospice managers ensured staff were listened to. The hospice provided a Freedom to Speak up guardian who was a trustee, therefore, separate from managers. Notices on display stated “Speaking up is about anything which gets in the way of providing good care. When things go wrong, we need to make sure that lessons are learnt, and things are improved’’. This also encouraged staff to talk about “when things are good, but could be even better, we should feel able to say something and be confident that our suggestion will be used as an opportunity for improvement”. Staff we spoke with said they felt listened to and could always put forward a good idea.

There was a culture of kindness and respect between colleagues and from those in other organisations. Patients were supported by staff who felt valued by their leaders and their colleagues. They had a strong sense of belonging and the latest staff survey data from all hospice staff showed good return rates and that 100% of staff were enthusiastic about their job, 91% felt they were treated with respect and 94% felt personally safe at work, 96% of staff were clear about their job role, 89% felt valued and 87% felt encouraged to become involved in decision making.

When asked their feelings about working at Willow Burn, staff said they felt respected, supported and valued. Staff felt positive and proud about working for the provider and their team. Staff described good things such as their colleagues, the environment, supportive leaders, making a difference and flexibility. Nursing vacancies were rare, and staff interested in working at Willow Burn often applied for a volunteer role or joined the nurse bank before moving into a permanent role.

Staff had access to support for their own physical and emotional health needs. Managers made time for debriefs following difficult incidents and undertook wellbeing checks during handovers. Staff and volunteers were able to make use of the wellbeing facilities provided at the hospice including complementary therapies provided by the day service.

The hospice ran events to thank volunteers for their contribution. These events were important to foster a feeling of inclusion and provided the opportunity for social interactions. The hospice also had volunteer notices which encouraged community and interaction.

There were clear policies that supported staff and managers by providing clarity, clear expectations and ensuring consistency. This encouraged a healthy work life balance through flexibility and a family-friendly approach. Psychological safety was promoted by means of open communication, urgent debriefs after incidents or difficult events, regular one to one meetings with managers, open door access to senior leadership and the human resources team.

The Family Support Team offered informal debrief and support sessions to staff and volunteers when something traumatic had happened, or a team had been particularly impacted by a situation.