Teesside Hospice Care Foundation

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

The hospice had a clear, shared vision based on equality, inclusion and community needs, with strategic aims based around delivering safe and effective care to all people when they most needed it.

Staff and leaders demonstrated a positive, compassionate, listening culture that promoted trust and understanding between them and patients who used the service. The culture was focused on learning and improvement and there was mutual trust and respect between leadership and staff. Staff were highly motivated and consistently felt well-supported by leaders.

Governance and management systems were robust and enabled leaders to identify information about risks, performance and outcomes. Continuous learning and improvement were embedded with strong collaboration across partners to develop and deliver joined up care.

At our last inspection we rated this key question good. At this inspection, the rating 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 had a very clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities.

Staff took ownership of the provider’s vision and values and how they were applied in the work of their team. Staff in all areas including volunteers understood and supported the vision, values and strategic goals.

The vision and values and strategic goals were created through consultation with local NHS partners, commissioners, beneficiaries, staff and donors. Leaders talked to people using the service on a regular basis. No specific focus groups had been formally held over the previous 12 months and leaders believed they received constructive feedback through other forums such as conversations with individual patients and loved ones, patient and carer feedback. Feedback and knowledge from local community groups was used to understand the needs of the local community and the barriers to accessing services. Information from local groups was brought together with clinical insights, financial oversight and dashboard data, for example waiting lists and patient experience reports.

Strategic priorities were aligned to local plans in the wider health and social care economy and designed to tackle health inequalities. There was a demonstrated commitment to system-wide collaboration. Strategic priorities were reviewed annually and reset for the coming year. This information was made publicly available on the providers website for transparency. Partners within the NHS told us the hospice team linked in regularly to seek feedback and consider ways to make future improvements to services.

Leaders were proud to explain they believed staff were absolutely embedded in the culture of shaping the future direction of the service. A sense of continuous improvement was described and attributed to staff being empowered to move the service forward with the overarching aim of being there for everyone who needed them.

Leaders were committed to investing in the workforce with plans to retain and grow their own workforce through, for example, student placements and volunteer development opportunities.

At the time of inspection, a merger with another local hospice was taking place. Staff told us they had little information about how this would look going forward and had received little advance information on this merger. However, staff did not feel information had been withheld and understood that senior leaders were still developing the future structures that were only in the very early stages. Staff said they felt they would be given information if they asked and were aware of an upcoming away day where information would be shared in more detail and opportunity would be provided for contribution towards discussions of the future direction. Staff we spoke with saw this as a positive move and had no concern about the senior leader’s ability to manage the merger whilst maintaining the high standard of business as usual at Teesside Hospice.

Staff could explain how they were working to deliver high quality care. Leaders monitored and reviewed progress against the strategy systematically through board meetings, supported by oversight from the trustee board.

The evidence showed an exceptional standard. The service had exceptionally inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty.

Leaders were compassionate, inclusive and effective at all levels. Leaders had a diverse range of expertise and demonstrated the high levels of experience needed to deliver sustainable and high-quality care. Leaders were highly invested in understanding what was important to people in their work. Leaders used theoretical evidence-based knowledge alongside actively listening to the staff groups.

Leaders had an exceptional understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care. This knowledge and understanding extended beyond the day to day running of the clinical services provided within the hospice buildings to the wider community challenges. Leaders also demonstrated an excellent understanding of the challenges financially in sustaining care provision. Leaders consistently considered and reviewed the socio-economic climate and political landscape. They were aware of growing need in the area and changing needs, for example, younger people with increasingly complex conditions and wider family support needs. Leaders supported staff who put forward ideas for creatively engaging with wider communities and enhancing flexibility in meeting people’s needs at times when this mattered.

Leaders were proactive and forward thinking when considering additional ways to reach more people whilst also increasing financial income. For example, initial work had begun to provide chargeable services to private sector industries where bereavement support was of benefit. This had arisen out of the knowledge of a death in a local industrial company where support was seen to be beneficial for the wider workforce around managing staff experiencing bereavement.

Paid and voluntary staff were equally supported and respected as members of the team. Leaders recognised volunteers were essential in enabling the service to continue to provide exceptional quality care. Volunteers were offered development opportunities and there were examples of volunteer staff going on to take up paid roles. For example, one volunteer had gone on to complete a return to nursing course and re-entered the workforce as a registered nurse.

Leaders were visible within the service and staff told us leaders were consistently approachable. We saw leaders engage with people attending the service during our visit. A senior on call rota had also been formally implemented ensuring availability of senior leaders out of hours.

Leaders were cited on the need for a reliable and retained workforce for sustainability. Leaders understood the existing workforce and were able to articulate comprehensive opportunities available for staff development including planning for the future for sustainability of a skilled and dedicated workforce. For example, each staff member had an individual training budget per year; early conversations were taking place about having a rotation of staff with the local NHS services for staff development providing opportunity for joined up sharing and learning. The service also provided placements for student nurses. This supported recruitment into the workplace.

The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Open, honest and transparent conversations were encouraged at all levels. Staff told us they felt they could raise any concerns with immediate line managers or senior leaders. If staff wished to ask questions confidentially there was a post box available for staff to post queries for the Chief Executive Officer (CEO) to answer. Staff told us responses would be shared through team meetings and staff bulletins. This was recognised as a safe and effective way to have questions answered without any fear of detriment.

Leaders actively promoted staff empowerment to drive improvement. All staff we spoke with were confident they would be listened to and their ideas for improvement would be acted on.

There was a formalised Freedom To Speak Up (FTSU) route accessible by paid and volunteer staff. There was a designated FTSU guardian. Staff told us they rarely used this route. We heard there had been a small number of concerns raised formally over the past year and were often resolved effectively and quickly.

Management of FTSU concerns was viewed as a means of safeguarding staff. Themes were raised with the CEO and included as part of the safeguarding report to the board.

There was a FTSU procedure presented in a way that supported a positive culture around speaking up. This was supported by a Whistleblowing Policy.

Trustees were visible and told us they would make themselves available for staff should they need to.

The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Equality and diversity were embedded into everybody’s practice. Staff told us they no longer had equality and diversity champions because everyone became a champion once they were employed through training received and routine practices such as putting pronouns on emails.

The service had sought out specific training and education for understanding diverse population groups such as the LGBTQ+ community.

Staff were able to apply to work flexibly. For example, working arrangements such as later start times or shorter days had been made to support people with personal circumstances such as caring responsibilities and physical health conditions.

Managers put reasonable adjustments in place for staff members to help them carry out their role. For example, standing desks for people with musculoskeletal problems, phone amplifiers for hard of hearing, adjustable keyboards for people with arthritis. Team meeting information was shared in a variety of ways to suit people’s learning styles. For example, presentations, visual and written information.

The People Team collected data to support equality monitoring of staff within the service to ensure it is diverse in its make-up and representative of the patient group. The data collected was constantly under review and changes to the way in which data was analysed or collected altered with any new learning or insights into diverse groups.

The evidence showed an exceptional standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver high-quality, sustainable care, treatment and support. They always act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

There was a clear governance framework in place. Staff understood the board structure and line management responsibilities. There was a dedicated team of trustees with a range of backgrounds and experiences. Leaders and trustees felt the board had the right balance of clinical and commercial expertise to support the sustainability of the hospice. The board structure had recently been changed to make committees specific with clearly aligned trustee members. This enabled trustees to have a higher-level overview and decisions requiring board consideration to be discussed accordingly.

Staff understood what must be discussed at team, directorate and board level to ensure essential information was shared. Meeting minutes demonstrated clear links between each committee or meeting.

Themes from incidents were routinely reported and trends identified. Staff made changes when themes were identified. For example, changes to cleaning routines within the IPU to match individual patient routines and prevent risk of falls associated with cleaning during higher periods of mobilisation.

Staff undertook an extensive range of local clinical audits. The audits were thorough, provided assurance and staff acted on the results when needed. For example, we saw documentation audits included patient specific naming within care plans. We saw evidence of regular review of audit results through Clinical Audit and Quality Improvement meetings.

Policies were available for staff. There was an overarching policy schedule used to track policies due for renewal. Policies were updated when they were due for renewal or sooner if changes were implemented. We saw some policies were externally owned, for example, from local NHS providers. The service ensured any externally owned policies were reviewed internally and if determined as fit for purpose would continue to be used subject to trustee agreement and risk register considerations.

A new compliance system was in place for managing risk. Incident reporting had been rolled out on this system and environmental risk assessments were being added. Not all environmental risk assessments were up to date at the time of inspection. However, this was noted to be due to the implementation of the new system and priorities for updates had been identified. Priorities included risk assessment relating to patient facing work. Progress was reported to the board.

The compliance system allowed for improved monitoring of incidents and quicker management of repeated incidents, for example a door guard repeatedly falling off could be flagged and replaced rather than multiple short-term fixes.

Staff maintained and had access to the risk register at departmental level. Staff could escalate concerns when required. Risks were escalated from departments to committees and then board as required. There was a clear risk review framework from departmental teams to board. Risks were RAG rated and those rated red were taken to board. Staff concerns matched those on the risk register.

The service had a Major Incident Policy and Business Continuity Plan including plans for emergencies, for example, power outages or need for emergency evacuation.

Where cost improvements were taking place, they did not compromise patient care. For example, the service was looking into the use of Artificial intelligence (AI) to reduce documentation time and increase clinical time. Small changes were made to save time such as checking of first aid kits. A tagged system was in place, with the next check date set according to the earliest expiry date of items within the kit, or sooner if the tag had been broken and the equipment used. This reduced the need for repeated monthly checks where equipment had not been accessed, while maintaining assurance that items remained safe and fit for use.

Leaders had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care. We reviewed Quality Performance Committee minutes and saw detailed review of data, areas where better data was required, actions to address improvements to data and examples of how data was used to review appropriateness of key performance indicators.

The hospice planned to move towards real time actionable data rather than static data collected at a single point in time.

The team were implementing annual staffing reviews using data from the previous year to support future staffing requirements.

There was a member of staff dedicated to leading on data. The hospice team were leading the way locally in gathering data electronically from a nationally recognised standardised assessment questionnaire. This allowed easier access to statistics.

Information was in an accessible format, and was timely, accurate and identified areas for improvement.

The evidence showed an exceptional standard. The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always share information and learning with partners and collaborate for improvement.

Leaders were committed to consistent and constructive engagement with external stakeholders for the benefit of the local communities. Rigorous and constructive challenge was welcomed from people using services, stakeholders and the trustee board.

The hospice was actively involved with the local Integrated Care Board (ICB) and collaborated closely to consider local need and how services across the ICB area could work together to meet patient need. We reviewed minutes of quarterly team meeting minutes with the ICB and saw consideration of the wider community needs through these meetings. For example, bed management co-ordination work across a number of local hospices was to be taken forward by Teesside Hospice to reduce duplicated referrals to a number of hospices. We saw challenge was taken on board from the ICB and actions implemented to address points raised.

Dedicated time was given to developing collaborative working relationships with other health and social care services. The hospice had some long-standing well-established partnerships such as with the local NHS acute trust palliative care services, head and neck cancer services, MND team, respiratory team and the local NHS mental health trust psychiatric liaison team. Close working relationships also existed with the social care teams. Feedback from these partner organisations was positive and demonstrated close working relationships where shared learning and collaboration were consistent and of high quality for the seamless provision of care for people in the local communities.

The hospice team had recently partnered with a community organisation to create better end of life outcomes for those struggling with addiction, homelessness and other associated health issues. Working in partnership, the two services were able to focus on how to work with people who have been historically ‘hidden from mainstream’ services where there has been little ability for services to adapt to meet needs. The hospice team were praised for creating direct accessible routes to care on the patient’s own terms whilst ‘stamping out stigma’.

The hospice was committed to always sharing learning with partners and working together to improve people’s experiences. For example, there were two bespoke study days a year with the local mental health liaison team.

The hospice worked closely with local hospice networks and placed emphasis on sharing resources. The hospice team understood the impact to the local communities within the North Eastern region when hospices were not able to provide sustained care. Therefore, staff at all levels worked consistently to constructively engage with all partner services and seek new opportunities to diversify and grow in the direction required by the local communities.

The hospice team worked closely with the wider hospice network in the North East area, for example, the IPU lead met with equivalent colleagues in other hospices, the Director of Nursing Quality had regular contact with peer colleagues and the facilities manager worked closely with other hospice facilities managers across the local network.

The service had begun to develop links with local care homes to support delivery of palliative care in care homes and create more formalised step up and down models. This work was in the early stages at the time of inspection. One care home had been visited and early conversation about how to work together had taken place.

The hospice actively monitored referrals from other agencies and looked at reasons for changes in referral patterns to enable better joined up working. For example, we saw there had been recognition of an increasing number of referrals for counselling from another provider. This was promptly addressed to make sure people were able to access services from the most appropriate place.

The evidence showed an exceptional standard. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Teesside Hospice had an embedded approach to learning and improvement with a strong emphasis on engaging in work nationally, locally and immediately within the service. Staff were empowered to develop opportunities for improvements and innovation that led to changes in care delivery. Senior leaders described the culture as one of continuous improvement and staff were “absolutely embedded in the culture” because senior leaders “empower staff”.

On a national level staff proactively sought opportunities to participate in a diverse range of research trials. For example, staff wellbeing and clinically assisted hydration were two national trials the teams had recently engaged with and were awaiting outcomes to determine appropriate changes to practice. Staff had carefully enlisted patients to participate in the hydration trial.

On a local level the team engaged with partners in service development projects. For example, the team had linked in with a consultant to engage in a Chronic Obstructive Pulmonary Disease (COPD) project and a widening access project with a local team supporting people struggling with homelessness, drug and alcohol use.

Within the immediate service setting staff used quality improvement methodology to embed sustainable models of care. For example, single nurse administration of controlled drugs had been introduced following a comprehensive training package implemented by the hospice. Individualised electronic care plans were developed and ongoing refinements made to these in response to feedback and regular audits. Improvements had been made to information sharing processes with GPs. A wellbeing index had been introduced and formal review was underway.

Staff also undertook research projects using recognised research methodology as part of ongoing learning and development through higher education courses. For example, an evaluation of the effectiveness of workforce planning tools to support decision making on effective staffing levels to meet need on the inpatient unit.

Staff engaged in review of their own services and sharing good practice through attendance at national and local conferences. Staff, routinely engaged with special interest groups for example the physiotherapy special interest group for palliative and end of life care.

The service was also committed to innovation in environmental and sustainable goals for the future, for example an environmentally friendly waste system and a proactive system for replacing electronic equipment for longer term environmental gain.