14 September 2016
During a routine inspection
East Lancashire Hospice is a charity which provides a range of hospice services for adults with a life-limiting illness living in Blackburn, Darwen, Hyndburn and the Ribble Valley. The hospice is purpose built and provides accommodation on the inpatient unit for up to 10 people. The hospice also provides community services including Hospice at Home and a day service which provides creative and support therapies (CaST). The CaSt service provided at the hospice is based on a delivery model which has moved away from traditional day therapy to providing support and well-being focused on normalisation, rehabilitation, choice and independence. The aim of the service is to help people to achieve a good quality of life through patient led therapeutic activities, equip people to adapt to illness and empower them to make the most of their life. In addition the hospice offers a 24 hour telephone advice line for professionals, a range of complementary therapies, counselling, support for carers and a bereavement support group.
The hospice is close to public transport routes and is situated in a residential area of Blackburn. The hospice is set in well-maintained gardens with adequate parking and clearly defined parking areas for disabled visitors.
Services are free to people, with East Lancashire Hospice receiving some NHS funding; the remaining funds achieved through fundraising and charitable donations.
At the time of our inspection there were six people being cared for on the inpatient Unit, 142 people being cared for in the community and 67 people attending the CaST service.
There was a registered manager in place at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission 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. The registered manager was also the Chief Executive Officer of East Lancashire Hospice.
People told us they felt exceptionally safe when accessing services provided by the hospice. This was because of the outstanding kindness and compassion demonstrated by hospice staff and volunteers. People who used the hospice told us staff would not hesitate to go the extra mile when caring for them. We saw the importance staff at the hospice placed on supporting families and carers of people with life- limiting illnesses in order to improve the well-being of all concerned; this included the provision of carer and bereavement support, complementary therapies and counselling.
Staff treated people with sensitivity, dignity and respect. People's emotional, cultural and spiritual needs were met by staff who were knowledgeable and confident to care for and comfort them. Families and those that mattered to the person were supported to spend quality time with them.
All staff had received training in safeguarding adults. In addition the hospice had developed a culture in which staff were supported to report any concerns, no matter how small, to senior staff. Safeguarding forums were in place to provide staff with the opportunity to discuss concerns and ensure referrals were made to appropriate agencies; this helped to ensure people who used the service were protected from harm. The professional responsible for delivering safeguarding training to the hospice told us they found staff to be extremely committed to ensuring the safety of people who used the hospice.
There were sufficient numbers of staff available to provide tailored, individual support to people, both in the hospice and in the community. Staff and volunteers had been safely recruited.
People received excellent care, based on best practice from an experienced and consistent staff team. Staff were supported through training to develop the knowledge, skills and confidence to be able to meet people's needs in an outstanding and individualised manner.
All staff and volunteers completed a comprehensive induction programme. Staff were expected to complete a workbook to demonstrate knowledge in all the topics covered. The induction workbook produced by the service was so highly regarded that it had been purchased by over 20 different hospices in the UK. This demonstrated that East Lancashire hospice was at the forefront of developing innovative resources to train and support staff working in palliative care services. An innovative and creative training programme was also in place which helped to ensure staff had the skills they required to communicate effectively with people who used the hospice, families and professionals.
Hospice staff were committed to promoting excellent end of life care for people in East Lancashire, by providing a programme of education and training for a wide range of health and social care professionals working in care and nursing homes and in the community. This helped to ensure more people received high quality end of life care from skilled staff in their preferred location and avoided unnecessary hospital admissions.
Good systems were in place to ensure the safe handling of medicines. People were cared for in a safe, secure and clean environment. People were protected because risks were identified and managed. The risks of cross infection for people were reduced through training for staff and robust infection control procedures. The ethos of the service was that people in the inpatient unit should feel that they were in a 5 star hotel and spa rather than a hospice. This was achieved through the use of high quality fixtures and fittings, aimed at ensuring people’s comfort and privacy as well as the artwork on display throughout the building.
Staff were supported to develop and implement creative ways of improving the outcomes for people who used the hospice; this included both exercise and rehabilitation programmes. We saw that staff had presented the findings from the programmes they had introduced at the national conference organised by Hospice UK. This demonstrated the service was a role model for excellence in practice.
People had access to high quality food, and their nutritional and hydration needs were met by excellent catering services. We noted there was a commitment to further improving the range of meal options available to people throughout the day through the introduction of a ‘light bite’ menu.
People's legal rights were respected because staff understood their responsibilities in relation to the Mental capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People knew how to complain and were confident any concerns would be taken seriously. Staff were committed to learning and responding to people's feedback and experiences.
People who used the hospice were supported to make choices and to have as much control as possible about what happened to them both before and after their death. They and their family members were consulted and involved in planning their care. People were also supported to discuss and make decisions on their preferred place of care at the end of their life. Staff were aware of the action to take to uphold a person’s rights should they be unable to consent to their care and treatment in the hospice. The skills staff developed through the hospice’s innovative communication training programme enabled them to have difficult conversations with people in a sensitive and caring manner.
The hospice was proactive in reaching out to communities who did not traditionally access their services, including people who identified as lesbian, gay, bisexual or transgender as well as people from minority ethnic communities. Innovative methods, including the use of social media and video messaging, had also been used to inform the local population about the services provided at the hospice in an effort to dispel myths and encourage people to access the support available to them.
People told us the leadership team in the hospice was exceptional in the care and support they offered to staff, volunteers and everyone who accessed the service. We were told there was an open and transparent culture in the hospice which encouraged people to express any concerns or complaints they had.
People received a consistently high quality of care because senior staff led by example and set high expectations about standards of care. Staff and volunteers spoke positively and passionately about working at the hospice. They told us they received excellent support and guidance from all the managers in the service. We saw staff had regular team meetings and other informal opportunities to enable them share good practice.
The leadership team in the hospice demonstrated a commitment to service improvement. Staff, volunteers and people who used the hospice were regularly asked for their views and ideas about improvements which they felt could be made. We saw that action had been taken to respond to ideas and suggestions people had made. This demonstrated people who used the service, their families and carers, staff and volunteers were all involved in shaping the future of the service.
There were robust systems in place to monitor the quality of care provided in the hospice; these included ‘closing the loop’ which helped to ensure lessons learned from accidents, incidents or complaints were shared across the service.