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St Luke's Hospice -Turnchapel Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 20 October 2016

St Luke’s Hospice, Turnchapel serves the people of Plymouth, South West Devon and East Cornwall. They provide palliative symptom control and end of life care, advice and clinical support for people with progressive, life limiting illnesses and their families and carers. They deliver physical, emotional and holistic care including bereavement counselling support, a lymphoedema service which provides advice and treatment (for people who experience swellings and inflammations usually of arms and legs) and an outpatient service. They offer occupational therapy, complementary therapies and physiotherapy, chaplaincy and spiritual support, as well as social workers, clinical nurse specialists and volunteer services. The hospice inpatient unit at Turnchapel was purpose built can care for up to 12 adults. The average length of stay is two weeks. The service provides acute specialist palliative care for people and does not provide a respite service or longer stay beds. The majority of people are cared for by hospice community specialist nurses in the community, currently around 300 people on the active caseload.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. They held the post of head of quality and compliance and were supported by a leadership team that included the chief executive and directors and department managers.

The registered manager was open and transparent in their approach. They promoted the service mission of ‘Hospice without walls” providing and promoting high quality end of life care accessible to anyone. Staff demonstrated this vision in their practice and gave person centred, individualised care. All staff felt valued by the leadership team and supported to provide high quality care throughout the service.

The service provided outstanding end of life care which enabled people to experience a comfortable, dignified and pain-free death. The environment was accessible for people with disabilities. It was welcoming, well maintained and suited people's needs. Clinics, therapies and support groups were held in the unit and people, in wheelchairs or beds could enjoy the view looking out over Plymouth Sound. There were well maintained grounds which were also accessible for people to enjoy.

The service continuously looked at the local community to see how best they could provide the service and had done excellent work in identifying the needs of the local population developing services to meet those needs. This had resulted in the provision of a Crisis Team service in 2014. It was identified that at times people experienced unnecessary hospital or hospice admissions when they would have preferred to remain at home. As part of the service mission to provide a “Hospice without Walls”, the Crisis Team aimed to respond within an hour to provide a short 72 hour intervention to enable people to stabilise their symptoms and facilitate rapid discharge home from hospital or hospice.

The team of registered nurses and health care assistants operated 24 hours a day, 7 days a week. This assisted and supported families and carers to respond to people’s rapidly changing situations to enable them to continue supporting their loved one. The Crisis Team staff were employed by St Luke’s and worked closely with other health care professionals in the community.

St Luke’s Hospice staff also worked at Derriford Hospital, Plymouth where they provided a specialist palliative care service for any hospital patient with a progressive life limiting illness and working closely with an extended multidisciplinary team. Services included assisting hospital staff with people’s complex discharge arra

Inspection areas

Safe

Good

Updated 20 October 2016

The service was safe.

Staff were trained to protect people from abuse and harm and knew how to refer to the local authority if they had any concerns.

Risk assessments were centred on the needs of the individuals and there were sufficient staff on duty to meet people's needs safely.

Robust and safe recruitment procedures were followed in practice.

The environment was fit for purpose and well maintained.

Medicines were safely managed.

Effective

Outstanding

Updated 20 October 2016

The service was very effective.

People told us staff had outstanding skills and knowledge. They told us that staff understood and anticipated their needs which enhanced the quality of their support.

Staff went that extra mile to ensure people's needs were met in a holistic way including support for people's loved ones.

People benefitted from high quality end of life care within the hospice service but also in the wider community because the service took a vital and key role in the local community. They also provided training to a wide range of health professionals and workers empowering them to share learning and maintain high quality end of life care for people outside the service.

Staff were trained in the principles of the MCA and the DoLS and were knowledgeable about the requirements of the legislation putting it into practice in a sensitive way.

People benefitted from a service which provided food and drink in an individualised way depending on people's end of life needs.

People were referred to healthcare professionals promptly when needed. Staff worked in partnership with health professionals, sharing end of life expertise, to ensure processes benefitted people and supported their choices in a timely way.

Caring

Outstanding

Updated 20 October 2016

The service was very caring.

People's feedback about the caring approach of the service and staff was overwhelmingly positive.

Staff showed kindness and knew how to convey their empathy when people faced challenging situations. People valued their relationship with the staff team who often performed beyond the scope of their duties to meet people's needs.

The service was very flexible and responded quickly to individual�s changing needs or wishes. Staff communicated effectively with people and treated them with utmost kindness, compassion and respect.

People were consulted about and fully involved in their care and treatment.

The service provided outstanding end of life care and people were enabled to experience a comfortable, dignified and pain-free death.

Responsive

Outstanding

Updated 20 October 2016

The service was responsive.

The hospice continually used knowledge of the local community to develop a service which best met local needs including vulnerable groups.

The service provided person-centred care based on best practice and focused on continuous improvement. People's care and support was planned and reviewed in partnership with them to reflect their individual wishes and what was important to them.

People benefitted from a service where their experiences, concerns and complaints were routinely listened to and used to further improvement.

Well-led

Outstanding

Updated 20 October 2016

The service was exceptionally well led.

The leadership team and registered manager provided outstanding and compassionate leadership and support to ensure people needs

were met.

There was an open and collaborative culture within the team who worked effectively with people, relatives, volunteers and other professionals to shape the service on offer and ensure people's health social and wellbeing needs were met.

A committed and stable staff team showed willingness to learn from mistakes and improve because they felt supported and were well trained.

Information about the needs of the local population had been used to develop specialist support in innovative ways to further the mission of �Hospice without Walls�. For example, crisis team, hospital team, prison, dementia, compassionate community and homeless programmes.