Nottinghamshire Hospice

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Feedback from people and staff was positive about the quality of end of life care provided by the hospice. The board and senior management team had a clear vision and strategy to ensure the delivery of high quality care and treatment.
There was a shared direction and culture throughout the service and an emphasis was placed on continuous improvement of the service and best practice. Leaders supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.
People's views were sought and valued. The hospice played a leading role in promoting end of life care within the local community and developed strong links with community groups.
At our last assessment we rated this key question good. At this assessment the rating has remained the same. This meant people’s needs were met through good organisation and delivery.
 

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The focus for all staff and leaders was on the needs of patients receiving care, their families, loved ones and care givers.
The service had an open culture where everyone could raise concerns without fear.
Staff and volunteers described the culture they worked in as like being part of a family.
Staff said that the service had an open and welcoming culture, where they felt they could raise concerns with both their colleagues and leaders without fear. There was a genuineness among staff that having to raise concerns about others was an exceptionally rare occurrence.
Staff told us that they felt respected, supported and valued. We spoke with leaders who aimed to promote a team ethos of caring for patients with dignity and respect no matter what their role within the service. We observed positive interactions between all members of staff regardless of seniority.
Staff continually demonstrated a clear understanding of the hospice vision and values and what they wanted to achieve. Staff were proud of the service and wanted to deliver the best possible care where people were supported to manage their life limiting conditions and spend their final days peacefully.
There was a clear sense of teamwork across day hospice staff, and everyone spoke very highly of their colleagues. When talking with staff it was clear that their priority was focussing on the needs of the patients they cared for.
 

Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in and around the for patients and staff. They supported staff to develop their skills and take on more senior roles.
Staff told us they were encouraged to speak up and discuss their concerns openly. When staff had raised concerns, they felt the management team could take appropriate action. Staff felt confident they could raise concerns or risks openly.

Although some staff were worried about redundancies and the proposed reduction of services due to the lack of funding, most staff we spoke with had confidence in the senior leaders to manage this as well as possible.
During our assessment the chief executive attended the Wellness day care session, which staff said was a regular occurrence.
Leaders engaged with staff and used staff survey results to explore issues and discuss solutions and improvements.
 

QS Score:
Score: 3
Managers and staff understood the importance of staff being able to raise concerns without fear of retribution. The hospice had policies on speaking up and raising concerns and whistleblowing.
The hospice had appointed 3 freedom to speak up guardians (FTSUG) which reflected national guidance and whom staff could talk to in confidence if they had concerns or felt they needed support. Staff were aware of the freedom to speak up guardian role and details of what freedom to speak up was, and who to contact.
Staff who we spoke to told us the culture within the service supported them to speak up and report any issues or concerns to their managers. Staff told us they felt confident to escalate matters if they felt their concerns were not being responded to.
 

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The service had effective systems to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk. They had a clearly defined purpose for the Hospice at Home service and staff were trained to deliver care in line with this purpose. Staff contributed to decision-making through the consultations to help try and avoid financial pressures compromising quality of care. The head of governance was responsible for policies and procedures.

Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

Performance dash boards were produced for the board on a quarterly basis which included reports on audits, mandatory training, incidents, safeguarding and complaints.

Incident review meetings took place every 2 weeks, where the main issues discussed on the risk register were recruitment and retention, management of change, and the bereavement waiting list.

Staff were encouraged to undertake secondments to parts of the service they had not previously worked and were encouraged to report incidents, for which they received feedback.

Senior staff and executives were present and visible daily in the hospice.

The hospice worked with local health care partners to ensure there was a good understanding of local needs and improve the care they provided. These included commissioners and stakeholders as well as other providers of care and support across Nottinghamshire. For example, the hospice worked in partnership with Nottingham Trent University on a number of projects, which included appraising their digital transformation strategy, reviewing the people services strategy regarding recognition and retention of staff and the assessment of the hospice carbon footprint.
The hospice was part of the Mid Nottinghamshire End of Life Care Together Alliance which is a partnership of 7 different organisations that works to improve the care and support for people living with a terminal illness and their families. The alliance consists of healthcare, social care and voluntary sector organisations as well as lay individuals.

Surveys were sent to the people who used the service to obtain feedback on the care provision and if it was meeting their needs. The feedback was used to improve services and a ‘You said we did’ feedback actions information document was published 4 times a year.
Recent feedback had been that more funding was needed to offer bereavement counselling when it was needed, as the wait was too long to receive this. In response, the hospice implemented a triage service to ascertain the level of need, and a waiting list was implemented.
A seated yoga group had been developed in direct response to local need and as a tool to support patients in falls prevention.
 

QS Score:
Score: 3

All staff were committed to continually learning and improving services.
Staff described a culture of learning and of opportunities to develop their knowledge and skills. Staff were encouraged to attend multidisciplinary team meetings to develop their knowledge and understanding about end of life care, including to gain an understanding of different treatment options.
There had been a review the census data and Equality, Diversity and Inclusion (EDI) strategy had been developed accordingly. For example, one action taken included making the website accessible to people where English was not their first language.
Staff attended end of life learning events, weekly check-ins, and formal meetings hosted by partnership agencies to share learning and best practice.
The system of ‘Shadow Shifts’ was utilised by the hospice as an important part of the induction process. Shadow Shifts is the process where a new staff see one shift and then undertake one shift, when they feel confident and are considered competent to undertake these.