Nottinghamshire Hospice

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service was safe. People were safe because individual and environmental risks were assessed, and steps taken to reduce them. Risks were managed positively and did not restrict people's lifestyle choices unnecessarily. The service had procedures in place to protect people from potential abuse and unsafe care. There were enough staff with the necessary skills, experience and qualifications to meet people's needs and preference. People received their medicines on time and in a safe way. The environment was safe and well maintained. Good levels of infection prevention and control were maintained throughout the hospice.
At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.
 

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.

All new members of staff and volunteers underwent a structured and comprehensive induction training programme appropriate to their role. For example, one staff member told us about their privacy and dignity training, which was part of mandatory training, and how they put that training into practice when caring for people.
The service had a mandatory training and competency framework, compliance was monitored through the service’s training database. All mandatory training and competencies were reviewed on a regular basis to ensure that they met current guidelines and procedures.
The service set a target of 90% for mandatory training compliance. Data showed for the period January 2025 there was a mandatory compliance rate of 93%, thereby exceeding the target.

Leaders and staff were aware of their responsibilities for reporting and recording incidents and accidents.
Staff were confident to report incidents and were supported when things went wrong. Staff knew what they should report and when they should report it and to whom. The formal reporting system was easy to use, and staff were knowledgeable when using it.
Staff told us they felt comfortable raising concerns with leaders and felt they would be listened to.
All senior staff were knowledgeable about the duty of candour, there was a standard operating procedure that provided guidance to the requirements of duty of candour.

Safe systems, pathways and transitions

Referrals to the service were via the district nurses, GP’s, and specialist nurses. People their relatives, care givers and friends, were able to refer themselves for the hospice at home service, day care activities and alternative therapies.

Some referrals could be completed online others made by telephone.
Staff told us they relied on healthcare partners to make appropriate referrals to them so people’s clinical priority for care could be assessed.
The service had a referral policy which was stored electronically and easy to access for staff.

Referral to visit times were audited by the service and part of its annual audit plan. Data showed that for the period July to September 2024 the time from referral to visit of a patient for Wellbeing was 89% and for referral to visit for hospice at home it was 94% against the service target of 90%.
We attended a situation report (Sitrep) meeting which happened every morning at 08:30. At the meeting, all referrals to the hospice were triaged by a clinician, and the information provided to identify the most appropriate service to support the patient and family and the level of urgency. The meeting also discussed staffing, patient deaths and caseloads.

Staff kept detailed records of patients’ care and treatment. Records were clear, up to date, stored securely and easily available to all staff providing care.

The service provided care and treatment based on national guidance and evidence of its effectiveness. The hospice completed a range of audits, including audits of medicines management, record keeping and pressure ulcer care.

The service had guidelines policies and procedures that were up to date and accessible to staff on the electronic intranet based on current guidance relating to end of life care.
Keeping people safe, first aid and infection prevention and control were part of the mandatory training programme and were also easily accessible.
All members of the multidisciplinary team worked and interacted well with each other to enable a coordinated approach to the way in which care was delivered.

Staff also worked in partnership with external providers of end of life care in assessing, planning and delivering care and treatment. This included GP's, primary care nursing teams, allied health professionals, social care providers, secondary care and other voluntary sector workers.

Staff received training specific for their role on how to recognise and report abuse and understood how to apply it and to protect people from abuse. The service worked well with other agencies to do so. Staff received training specific for their role on how to recognise and report abuse.

The service had two safeguarding leads. Staff told us they followed the safeguarding guidelines and had attended safeguarding training, which was part of their annual mandatory training requirement. Data showed that all staff were trained to the appropriate safeguarding level for their role

Staff knew how to make a safeguarding referral, had a good understanding of when they would need to report safeguarding issues and who to inform if they had concerns.

Staff were able to describe situations, which would prompt a safeguarding concern and lead to a referral being made. For example, one staff member told us of how a patient had disclosed some very concerning information which was reported to Social Services. As a result of a social services investigation, immediate action was taken to safeguard the person concerned.

People were given the opportunity to raise any concerns confidentially with staff when at the hospice, or in their own home, or by contacting them by telephone.

Staff completed and updated risk assessments for each patient and removed or minimised risks. Risk assessments considered patients who were deteriorating and in the last days or hours of their life.
Staff used an appropriate tool to identify patient need and levels of deterioration. Patient needs were escalated appropriately, within the context of the service. Staff completed risk assessments for each patient on admission, using an appropriate tool.
We reviewed template documents which would allow the recording of initial and ongoing clinical information.
Social therapy activities were risk assessed for each patient; this was noted in their care plans.

We reviewed the hospice care risk register which had 18 documented risks. The level of those 18 risks ranged between 3 and 16. The highest risks associated with the hospice, concerned the operational working within the hospice at home team over a 7 day period. Each risk had the date the risk was added, the date it was last reviewed, who owned the risk and the mitigating actions undertaken.
Patients and their relatives described regular and open conversations about risks around their health. One person described their discussion with a staff member about the risk of falling due to their declining health and what options were available to help with this. They told us. “The staff here are amazing; they explained everything and were really supportive”.

The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank and agency staff a full induction
Staff were experienced, qualified and had the right skills and knowledge to meet the needs of patients. Staff completed training appropriate to their job role.
Staffing levels were appropriate to meet the needs of patients. The service used of a staffing tool help hospital staff measure patient acuity and / or dependency to inform evidence-based decision making on staffing.

Managers gave all new staff a full induction tailored to their job role before they started work. There was a structured induction programme in place which all staff completed when they started work.
There was a procedure to check that nurses and other health care professionals maintained their registration with their professional bodies.
 

All areas of the building were observed to be visibly clean and tidy as were the grounds and the gardens.
Patient areas we inspected were visibly clean, including the reception and waiting area. Staff were observed to be following the service’s arms ‘bare below the elbows’ protocol. Hand gels were readily available in all areas of the hospice.
Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
Staff followed infection control principles including the use of personal protective equipment (PPE), appropriately.
The service used records to identify how well the service performed with cleanliness, infection control and hygiene. Hand hygiene audits for the period July to September 2024 for the hospice at home team, showed a compliance of 93% and 100% for Wellbeing Group activities at the hospice.
 

All areas of the building were observed to be visibly clean and tidy as were the grounds and the gardens.
Patient areas we inspected were visibly clean, including the reception and waiting area. Staff were observed to be following the service’s arms ‘bare below the elbows’ protocol. Hand gels were readily available in all areas of the hospice.
Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
Staff followed infection control principles including the use of personal protective equipment (PPE), appropriately.
The service used records to identify how well the service performed with cleanliness, infection control and hygiene. Hand hygiene audits for the period July to September 2024 for the hospice at home team, showed a compliance of 93% and 100% for Wellbeing Group activities at the hospice.
 

The service followed best practice and local policy when prescribing, dispensing, delivering and monitoring medicines given to end of life care patients which included medications used in anticipatory prescribing.
Anticipatory medicines are medicines which are prescribed for key symptoms associated with last days of life (for example, pain, agitation, excessive respiratory secretions, nausea and vomiting and breathlessness) and are prescribed in advance for rapid symptom relief. Medicines, including oxygen and specially controlled drugs, were stored correctly.
If day care patients (Wellbeing) wanted to bring and self-administer their own medicines independently, they were supported to do this. A risk assessment was undertaken for all patients who wanted to self-administer.
We spoke with two patients who told us staff were very careful to ensure people were on the right medicines and dosages to keep them pain free and control their symptoms. They told us they received their medicines at the times that they needed them.
The service had a clear drugs disposal process in place. The records for this process were accurate and the practice was safe.
Data showed for the hospice at home team a compliance of 78% for medicines management, however, we could not find an action plan in place to improve medicines management outcomes.