Teesside Hospice Care Foundation

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Staff followed a consistent and high-quality approach to assessing, and reviewing patients’ health, care, wellbeing, communication needs and their mental health needs. Documentation was clear and accurate, including risk assessments, consent and treatment decisions.

Effective multi-disciplinary team working supported co-ordinated patient care.

The hospice demonstrated a strong culture for delivering evidence-based care, monitoring outcomes and improving care provision. The service planned and delivered patients’ care and treatment with them, including what was important and mattered to them.

Staff worked together and with others when assessing patients’ needs and shared information to maintain continuity of care.

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

This service scored 88 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed care records and spoke to staff about assessments. Staff told us they carried out holistic and comprehensive assessments of needs as a team at the point of referral to Teesside Hospice services. The MDT worked together to ensure each patient and their loved ones only needed to share their information once.

Staff developed care plans that met the needs identified during assessment. We saw care plans covered clinical, personal care and psychosocial needs, for example, diabetes and steroid management, mouth care and personalised goals. Care plans were personalised and holistic. The team used the ‘Individual Plan of Care’ (IPOC) for end-of-life care. The IPOC aligns with the ‘One Chance to Get it Right’ national approach. Audit results demonstrated care plans were consistently completed for 100% of inpatients within 24 hours of admission. Emergency Health Care Plans were also completed with 100% consistency.

All staff we spoke with told us they routinely updated care plans and individual goals daily if required for inpatients, or when things changed. We heard a piece of work had recently been completed to alter the way care plans were devised to ensure plans were fully individualised and could not be copied and pasted.

Pain was reviewed frequently through hourly rounding contacts with each patient. Individual pain scores were used. Staff also used observational skills to read, for example, non-verbal communication and expression of pain. Staff worked together with patients loved ones to recognise normal expressions and take advice from loved ones regarding when pain might be indicated. Staff were also able to provide anticipatory pain relief prior to procedures, for example, where moving was required.

The Wellbeing team promoted non-pharmacological pain relief options, for example, activities such as music or other creative activities as a distraction. The team recognised that building up self-esteem and confidence could promote greater engagement with alternative activities that in turn reduced pain or other difficult symptoms.

Risk of pressure ulcers and pressure relief requirements were assessed and reviewed through regular hourly rounding contacts. Pressure relief care plans were evident within patient notes.

Falls risk was assessed. Audits demonstrated patients at risk of falls were routinely assessed within six hours of admission 100% of the time. Where risks were identified, care plans were also implemented within 24 hours of admission 100% of the time. The nurse call system could be used to detect if a patient had got out of bed or chair.

For those who found communication more challenging staff used picture boards or interpreters and worked with loved ones to ensure a patient’s individual needs were fully understood.

The evidence showed an exceptional standard. The service always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. The team had taken part in a national trial for clinically assisted hydration at end-of-life care. Nine patients had been recruited for this trial and the team were waiting for results of the trial to be published with a view to implementing longer term changes in practice based on the trial findings.

There was an active nutrition and hydration steering group. This group ensured practice aligned with National Institute for Clinical Excellence (NICE) guidance, professional standards and end of life care principles. We spoke to staff and reviewed minutes from this group and saw evidence of dedication to trialling evidence-based interventions. For example, nosey cups were due to be trialled, and staff were encouraged to attend ‘Taste, Comfort and Care’ training. There was a whole team approach to planning and delivering including nursing, health care assistant (HCA) and catering staff along with all other members of the MDT.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. For example, there had been a trial of an evidence-based tool used for measuring patients’ independence in activities of daily living.

The hospice operated a link practitioner system. Registered nurses alongside a supporting HCA had link practitioner roles in areas that interested them, for example, diabetes care. The link practitioner was allocated six hours per month for the role which included keeping up to date with NICE guidance and other evidenced based guidance. Where appropriate the link practitioners were also linked to experts in the local acute hospital. They were responsible for ensuring all new evidence or changes to practice was reflected in staff competencies.

The team included a range of specialists required to meet the needs of patients and their loved ones. The MDT included doctors, nurses, HCA’s, occupational therapist, physiotherapist, dietician, pharmacist and social worker input. The team were equipped to provide a range of evidence-based interventions. For example, there were trained counsellors and therapists available to offer bereavement support and specialised interventions such as Eye Movement Desensitization and Reprocessing (EMDR). EMDR is a structured, evidence-based therapy designed to help people reprocess traumatic events. In addition, a range of complementary therapies and group intervention sessions were offered.

The counselling service provided counselling for children over the age of seven years. Work could be done on a 1:1 basis or through group sessions following structured approaches. This service also recognised local impact of death. For example, they would work into schools where a death had occurred impacting a community of children.

The service included the specialist lymphoedema service for the region. This was a service provided by Teesside Hospice and commissioned by the NHS. The practitioners within this service received specialist training in line with guidance and had individualised competencies for the role.

Leaders ensured all staff had regular appraisals that were individualised and meaningful. Appraisals were used as an opportunity to identify and review any concerns regarding performance. The percentage of clinical and care staff that had had an appraisal in the last 12 months was 88%. Half of those staff without an appraisal were new staff who had not yet reached the required time for completing an appraisal. The appraisal target for KPI was 85% although staff told us they aimed for 100%. Staff received regular supervision through 1:1 sessions.

Staff were empowered to identify their own learning needs in discussion with leaders. Staff told us they had opportunities to develop their skills and knowledge in interest areas and where they could enhance service provision. Leaders told us each individual staff member had an individual training allowance and were able to use up to a set amount each year. The aim was to support development in areas of interest and ‘link professional’ roles. For example, the complementary therapy staff had used this budget to become qualified in Reiki. Other staff had attended conferences to support link roles such as diabetes with this budget.

Leaders ensured that staff received the necessary specialist training for their roles. There was a designated education lead who was able to responsively source additional training to meet individual patient needs. The team recognised patients presented with increasing complexity and therefore, training had to be responsive. Staff were equipped at anticipating need and requesting extra training in advance to ensure they could provide safe care. For example, tracheostomy care had been identified as an increasing need. One member of staff was an expert in tracheostomy care and plans were made to train an increased number of staff. The lymphoedema service had recognised that some patients were at risk of forming a dependency upon the service. In recognition of this training on attachment styles was being given.

Leaders explained they dealt with poor staff performance promptly and effectively. They described how this was done in a supportive way using individualised action plans that were measurable and achievable.

The evidence showed an exceptional standard. The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

Staff were committed to working collaboratively with outside health and social care services. A weekly locality MDT was held and attended by hospice staff, local NHS hospital teams and district nursing teams. We saw comprehensive discussions and detailed information sharing about patients known to all teams. Decision making for complex cases was clear and collectively done. There was clear evidence of respect between the teams. Appropriate and timely sharing of the relevant information meant people did not need to tell their story more than once. A recent externally completed environmental assessment noted the addition of a MDT room, stating this had been ‘additionally impactful, with both staff and families reporting improved communication and experience.’

The service was able to plan for admissions and discharges at the earliest possible stage through effective joined up working with the other local teams. To avoid duplicated referrals within the locality area there were clear lines of communication with the specialist palliative care team.

Internally the staff held weekly MDT meetings and daily handovers. The MDT meeting was attended by a range of health professionals including medical, nursing, AHP and healthcare assistant representatives from the in-patient and wellbeing teams. Staff consistently took a holistic approach to planning patients care. We observed thorough discussion regarding each in-patient and what was important to them. The team demonstrated a joined up, flexible and responsive approach to ensuring the needs of patients and their loved ones were met. For example, the team recognised when a family member may need additional support and when a patient recently admitted required space to adjust without interruptions from staff.

The staff had strong links with the local social care team. We heard examples of joined up working and shared learning. For example, where there had been complex deaths including safeguarding concerns

Collaborate working extended to local voluntary organisations and other providers of support. Staff looked for innovative ways to deliver services to the local population, for example, providing a service within the local community hubs and GP services. This enabled stronger relationships with other community services and supported the longer-term vision of Teesside Hospice “to be there for everyone who needs us”.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff supported patients and their loved ones to live healthier lives through individual goal setting on referral into the service. Feedback from patients loved ones evidenced the value placed on supporting wellbeing for all people and not only the patient.

The Lymphoedema service provided guidance on the best way to manage illness to enable people to carry on living life their way. For example, through use of massage, techniques and advice.

The Wellbeing and Outreach team offered a range of time limited focussed groups aimed at empowering people with life limiting conditions to manage their health and wellbeing so they could live life to their full potential. For example, managing breathlessness and fatigue.

The Bereavement support team worked toward empowering individuals to live a balanced and healthy life through supporting psychological and emotional wellbeing.

The teams recognised the emotional impact of living with chronic illnesses and provided emotional and psychological support to enable people to manage their wellbeing and response to their illness.

The evidence showed an exceptional standard. The service monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

The team continuously monitored care and treatment using standardised tools at designated intervals throughout patients’ involvement. For example, the counselling and wellbeing services used standardised anxiety and depression scales at the beginning and end of interventions. Views on care questionnaires were used to determine differing views at the beginning and agreed points throughout involvement. The teams were careful to get baseline measurements to ensure outcomes remained consistently positive. Outcome monitoring extended beyond patients receiving direct care or those receiving input from the counselling services. For example, there was also a bereaved carers questionnaire used to gather feedback to make improvements. Dignity curtains in IPU bedrooms had been implemented following feedback from this questionnaire.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes. For example, the Purpose T was used for detecting pressure ulcers. Additional measures were put in place to review pressure ulcers present on admission and measure where both deterioration and improvement happened. This supported learning from good practice. Electronic incident reporting systems in place allowed staff to determine the difference in numbers of pre-existing and hospice acquired pressure ulcers. Staff visited other hospices to review practice and compare approaches. Staff worked closely with other care providers to share positive pressure care management and promote continued management on transfer of care.

Audits measuring against national standards were completed, for example, end of life care was measured against criteria from the Leadership Alliance for Care of Dying People’s document ‘One Chance to Get it Right’. We saw the audit demonstrated excellent performance across 15 standards and high standard of compliance across five priority areas for care of the dying person.

The hospice carried out a range of routine internal audits, for example, but not limited to, antibiotic use, pharmacy prescribing, patient access, discharge procedures and wellbeing. We reviewed Clinical Audit and Quality Improvement meeting minutes and saw audits were routinely discussed, actions were identified and assurance of action completion was provided to senior leaders.

Where changes in practice had been made, audit tools were routinely updated to reflect current practice and ensure appropriate capture of information. For example, changes to documentation and record keeping had indicated a need to change the record keeping audit tool. This had been done promptly assuring alignment between audit and standardised procedures.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions about care and treatment. Staff communicated in a way and at a pace that supported people to understand all the information they needed to make an informed decision.

Staff understood when and how to assess whether a patient had the capacity to make decisions about their care. Decisions regarding capacity were correctly recorded.

Staff adhered to guidance when recording capacity and consent. They reviewed patients’ capacity on a decision-specific basis with regard to significant decisions.

When patients lacked capacity, staff worked with loved ones according to guidance to make decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

A resuscitation decision audit was carried out. Results from this audit had identified ‘excellent documentation of DNACPR and decisions even in complex situations.’