Teesside Hospice Care Foundation

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

The hospice was exceptional at ensuring patients were at the centre of their care and treatment choices. Staff decided, in partnership with patients and their loved ones, how to respond to any relevant changes in their needs. Services were tailored to meet the needs of individual patients and their loved ones in a way that ensured flexibility, choice and continuity of care. 

The service focussed on equity and service improvement through outreach to local community groups and ongoing development of inclusive practices. The service was committed to meeting the needs of the diverse population through analysis of gaps in access and service provision for the local population groups and those who may be more disadvantaged.

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

This service scored 93 (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 an exceptional standard. The service was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Individual plans of care were central to the delivery of tailored services. Plans were developed from the onset of involvement with hospice services. The Community and Wellbeing team were proactive in working with individuals to look at their needs on a person-by-person basis. The team took account of personal wishes and used recognised tools with professional judgement to determine individual risk levels.

Plans of care fully reflected patients physical, mental, social and emotional needs, including those related to protected characteristics. There was a proactive approach to understanding the needs and preferences of different groups of individuals. When staff were asked about reasonable adjustments, for example for autistic people, staff told us that each person’s individual needs were consistently taken into account. On the inpatient unit the layout of rooms, noise and lighting were considered. One partially sighted person had told staff they struggled to see tablets in the white medication cups so staff immediately arranged for coloured cups and coloured trays enabling the person to clearly see and manage their own medication.

An initiative had been implemented for patient led assessment of nutritional care. The team recognised that the standard nutritional assessment often used was not appropriate for palliative and end of life care. This initiative meant patient needs and wishes were always prioritised.

The teams consistently prioritised detail in considering person centred care. For example, a piece of work was being carried out to review the need for patients having their weight taken. It had been identified through a recent literature review that having a clear clinical rationale for weighing patients was more valuable than routinely recording weights for all patients within this care group.

The team had worked together with a local substance misuse service to ensure that documentation for care plans was tailored to individual client groups to fully embed person centred care.

Staff proactively engaged families and people’s loved ones in providing person centred care, for example, staff understood there were cultures where family members may prefer to provide personal care to their loved one themselves whilst others wanted to spend time engaging in different activities whilst the hospice team managed aspects of personal care. The team had daily conversations with patients and their loved ones to enable the team to respond immediately to any changes in wishes as care needs changed.

Staff enabled informed choice through ensuring information was available in a range of different formats to meet people’s needs. For example, the care of the dying booklet had been translated for a Somalian patient. Staff also engaged with different community groups to understand the cultural needs of members of the community accessing the services to truly embed a person-centred approach.

The facilities and premises met the needs of a range of people using the service. For example, larger rooms for family events, garden spaces with seating areas around the pond and separate space in the counselling building with bean bags and large screen television for people with younger families who did not want to go into the in-patient unit environment.

Staff used a My Way document for patients and loved ones to identify what was important to them. There were also ‘My Care, My wishes’ folders used within the community.

The evidence showed an exceptional standard. The service had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service was dedicated to understanding the diverse health and social care needs of the local population. There were designated resources aligned to understanding the local community and where needs were unmet. The service used their own data mapping alongside integrating themselves into the local Integrated Care Board (ICB) to ensure access to wider health needs analysis information.

The team proactively integrated their services into the local community to ensure services were flexible and joined up. For example, the hospice had begun a 12-month project with a local team bringing support services together for people struggling with homelessness, domestic abuse, drug and alcohol use. It had been identified that people from this group would not necessarily access hospice services but would benefit from the service if a creative way of engaging could be found. The team were able to take hospice care to places where people could access it, such as local community hubs.

The team worked in a consistently coordinated and responsive way with a number of other local services. They used creative approaches to providing integrated person-centered pathways of care involving other service providers, including for people with multiple or complex needs. For example, there were regular in-reach visits to the local acute hospital or daily phone calls if visits could not be made. Close working relationships existed with the respiratory team, head and neck cancer team, motor neurone disease team, the local community palliative care and district nursing teams. There was a long-standing service level agreement with the local mental health trust for joined up working. Active work was ongoing to strengthen the relationship with the local mental health services to identify ways to support people with long term mental health conditions.

The hospice worked closely with the local ambulance service to ensure joined up working and individual needs were met when people required transport by the end-of-life ambulance.

The hospice provided the Lymphoedema service for the Tees Valley and surrounding North Yorkshire area. This service provided different pathways dependent upon urgency of need and had the flexibility to provide home visits or clinic appointments. Care could also be provided on a one to one or a group basis. Thorough assessment of a person’s needs enabled care and treatment to be delivered in a way that met people’s needs whether this be through appointments or self-management at home with support from printed booklets or through accessing QR codes.

The wellbeing service offered a range of groups provided by a multi-disciplinary team aimed at living well and managing symptoms. People were able to attend for a fixed number of sessions. Staff worked with groups to encourage self-supported groups to continue or integration into other community groups once the time limited group had reached its end. For example, a social café was held in the hospice coffee shop twice weekly.

The hospice embedded itself into the local community through a range of charity shops and attendances at local events throughout the Teesside area. Volunteers supported these events who often had their own experiences of using the hospice and were able to share experiences.

The volunteer lead also worked closely with the local community groups to understand local needs. Proactive work was ongoing to attract volunteers from a range of backgrounds, for example, the local refugee support service and local colleges. One aim of this work was to attract a more diverse range of volunteers who could then also promote the value of the hospice services to their own local community groups.

The evidence showed an exceptional standard. The service was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service worked consistently to ensure that information provided for patients and those coming into contact with the service was accurate and up to date. Care was taken to present information in a sensitive way with careful consideration to wording of documents. For example, we reviewed meeting minutes and saw detailed discussion had taken place around wording and layout of documents. Patient information and leaflets were a regular agenda item on the clinical care steering group. This ensured information provided was consistently aligned to clinical care provision across all hospice services.

Record keeping was tailored to support person centred care. For example, treatment escalation plans (TEP’s) were written in a patient led way recording wishes before clinical recommendations.

Information governance systems included confidentiality of patient records.

The service complied with the Accessible Information Standard. Information provided on the website could be accessed in various formats through selecting the ‘accessibility adjustments’ button. This allowed, for example, different sized print, simplified reading options, reduction in distractions on the page. The website also included an accessibility statement requesting feedback on access to the site. The hospice supported the Web Accessibility Initiative (WAI). The WAI sets out guidelines on making websites accessible for all.

Information was available in different formats. For example, in printable booklets, through QR codes and in different languages. The team had planned to develop a task and finish group to develop information available and the approach used to communicate effectively with people with learning disabilities, particularly surrounding death and dying.

Staff routinely ensured that patients could obtain information on their rights. Social work provision was available to all who used the hospice. This included practical support and advice on completing wills, Lasting Powers of Attorney, benefits and other practical support. People did not have to ask for this information because it was made readily available through the assessment process once people accessed the hospice services. Support was provided on a one-to-one basis to provide information in more detail and routinely offered to groups. For example, the first session of the ‘Be In Charge group’ was facilitated by the social worker to share relevant information.

Individual service leaflets were available in a range of formats for people, for example lymphoedema service or occupational therapy leaflets. Leaflets and information was also interactive for patients and their loved ones to individualise. For example, there was a ‘Thinking Ahead / Preparing for Home’ leaflet that allowed space for writing who might offer support at home.

Information was consistently provided verbally to patients and their family members. All patients and families we spoke with told us they were provided with appropriately detailed information to meet their needs and were regularly updated.

The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The service had received two complaints in the previous 12 months. We reviewed these complaints and saw they were resolved in a timely manner. Patients received feedback from complaints including areas for future learning and changes to practice.

The service thoroughly reviewed all complaints and identified learning actions with changes to practice, for example, development of a new standard operating procedure regarding delivery of garments from the lymphoedema service. Learning from complaints and concerns was seen as an opportunity for improvement.

Information on how to complain was available throughout the hospice and on the website. Patients and loved ones we spoke with told us they had never felt the need to complain but they would be comfortable to find out how to do this if they needed. People consistently told us that all staff communicated well and involved them.

The inpatient unit collected and collated an annual feedback report. This was reviewed and changes made for example, an update to the welcome pack and a ‘Meet the Staff’ board was being developed. This supported breaking down barriers as people accessing the unit could recognise faces. Patients were also involved in decision making such as when purchasing new beds, patients were able to try different mattresses and provide feedback.

Staff recognised that feedback was consistently positive and therefore, learning from concerns or complaints was challenging. Staff used more informal routes to seek feedback from patients, for example, the wellbeing centre team routinely sought verbal feedback through groups to inform improvement initiatives and development of new groups such as the men’s group. The teams had also considered use of volunteers to ask questions about patient experience rather than clinical staff. This was due to be rolled out following recruitment of new volunteers taking place at the time of inspection.

Patients had recently had the opportunity to contribute to a national clinical trial regarding the terminology used to describe people receiving palliative care or oncology services.

Staff protected patients who raised concerns or complaints from discrimination and harassment. Staff told us that all patients and their loved ones were treat equally.

The evidence showed an exceptional standard. The service was exceptional at ensuring people could access the care, support and treatment they needed when they needed it.

Ensuring care provision was accessible by all went beyond the patient needs, extending to family and loved ones. The team recognised the inequalities carers may also face in accessing support. The team consistently identified the needs of patients and loved ones at the point of referral and considered where extra support or signposting was required to ensure equity in access.

Patients and families could be referred by other health professionals as urgent or non-urgent referrals. Urgent referrals requiring a same day admission were contacted the same day. For all other referrals contact was made within three days by an outreach nurse. The outreach nurse made contact by phone and arranged a mutually agreed time and place for an initial assessment. Email and letter options were also available. Telephone contact had supported reduction of ‘Did Not Attend’ (DNA) rates.

Staff followed DNA processes if people didn’t attend for appointments. Staff also recognised trends in DNA rates. For example, the wellbeing team had noted that men were getting referred but not attending so they looked for ways to engage better with men such as the men’s group.

A complex clinic had been set up to support people in the community waiting for hospice bed availability on the inpatient unit. The wellbeing team and inpatient unit team worked together to step people up and down into this clinic according to need. This meant people could access services when they needed to.

Staff made reasonable adjustments for patients, for example, equipment was provided to support independence and mobility. A recent external environmental survey described the hospice as ‘demonstrating a strong understanding of its user population, using activity data and feedback to inform service and environmental changes’.

Consulting rooms and clinical spaces were organised in a way to avoid any barriers between patients and clinicians. For example, seating was positioned in a way to promote social interaction. Complementary therapy rooms were situated within the inpatient unit and the wellbeing area for access by all people using the service.

There was medical cover day and night, a doctor could be contacted through the on-call system out of hours and would attend the hospice as needed. Patients and families had access to staff for support through the day and night. People reported there was ‘always someone to talk to which is comforting, especially through the night.’

The hospice IPU was contactable 24 hours a day for those who received care from the hospice teams. Any calls were discussed at handover and where necessary people were linked up with the most appropriate support.

For people unable to access the hospice using independent transport there was an arrangement in place with the local patient transport service and staff could make bookings for people. There was a specialist palliative care ambulance that could be booked to transport end of life patients.

The hospice was signposted and had sufficient car parking with easy level access into the building. The lymphoedema clinic had a separate reception area with designated parking for ease of access. The counselling service was situated in a separate building clearly signed. Each reception area had a lowered desk space for wheelchair users. Hearing loops were in situ. All patient areas where on the ground floor and signposting was clear. There was access from each bedroom and communal area onto the outdoor garden area. There was an external doorbell for people requiring assistance to access the inpatient unit as these doors had to be opened manually. There were changing facilities for babies and young children visiting the inpatient unit. All patient areas had accessible toilets located away from immediate waiting areas supporting privacy and dignity. A recent external environmental survey described the facilities as ‘family friendly’.

There was an onsite coffee shop, and loved ones were supported to access this or have food brought to them.

Leaders and staff were alert to discrimination and inequality that could disadvantage different groups of people in accessing care. For example, staff had listened to the voices of people accessing the homeless services locally who had identified they ‘don’t feel like they fit’ at the hospice. The team had sought experiences of other hospices to learn from in developing a more accessible service for this group of people within the community.

The team worked closely with other services to consider barriers to accessing care. For example, a close working relationship with the head and neck cancer team at the local hospital meant everyday barriers and challenges for this group of people where clearly understood. This group of people might be more self-conscious about aspects of their health condition such as drooling or slurred speech. The team worked with this knowledge to plan for home visits or joint meetings with the head and neck team to reduce barriers.

The team had begun to explore ways to work within Primary Care Network (PCN) areas to reach a wider population. They were in the early stages of working more closely with one PCN with smaller more isolated population groups where travel may not always be easy. Wellbeing groups were facilitated in community hub locations for those who did not want to access the hospice environment or found access to the hubs easier.

The evidence showed an exceptional standard. Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

Staff within the service promoted a culture in which the people using the service felt empowered to give their views. Staff clearly understood the challenges of operating within one of the most economically deprived areas of the United Kingdom and proactively sought creative ways to listen to people. The hospice charity shops were seen as a key feature in providing an accessible route in to understanding Teesside Hospice services available.

Leaders proactively used their knowledge of the local population groups to seek ways to address any local health inequalities. Data on use of the service was actively reviewed to better understand who was accessing the services and to understand where there might be areas of unmet need.

Staff had spent time understanding the challenges that homeless people faced. The service had been involved with a local LGBTQ+ organisation to understand and hear the challenges this group faced when accessing health services.

We reviewed feedback from one same sex couple who had experienced ‘not fitting in’ within other community settings. Their hospice experience was described as a ‘you and me the same’ connection where they were able to laugh and cry with peers whom they never thought they would connect with.

The team had also engaged with a local drug and alcohol service. Following this, documentation was reviewed to ensure that assessments were set up to seek the best information from people using drugs and alcohol to allow the service to best meet their needs.

Within the IPU there was one room set up as a bariatric room and a bariatric guide was being created by staff.

Staff were trained in equality, diversity and human rights. At the time of inspection, recruitment was underway for a new equality, diversity and inclusion lead. There was also a job advertised for a spiritual and pastoral lead to strengthen the work being undertaken with local faith groups.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage. An external LGBTQ+ organisation had independently reviewed policies and procedures to support equity in experiences. The service had won an award for the work in this area.

The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The Hospice had implemented the use of the ‘Deciding Right’ document. This is a regional initiative across the North East and North Cumbria designed to standardise how advance decisions are made and recorded, particularly in relation to end of life care or complex decisions. This is a framework endorsed by the NHS and includes colour coded documents to ensure care preferences are met. These documents include: advance statements, such as what matters most to a person, care preferences, beliefs and preferred place of care or death; advance decisions to refuse treatments people do not want in the future; Do Not Attempt Cardio-pulmonary Resuscitation (DNACPR) decisions; emergency health care plans, such as a quick reference for emergency services or actions carers should take in an emergency.

Patients were empowered to make decisions about their care and treatment and their future. Staff created personalised care plans with patients and their loved ones. Other health care professionals and relevant people were involved where required. The plans were developed in a sensitive and dignified way to ensure patients received the care they wanted at the end of life.

People who had used the service described a ‘straight talking’ honest approach to supporting planning. The approach allowed time for people to make plans that incorporated all family members and loved ones.