St. Peter’s Hospice provides care for adults with life limiting illnesses. They provide physical, psychological and spiritual care for patients in their own homes as well as at the hospice. At the time of our inspection they provided care for approximately 700 people living in Bristol, South Gloucestershire, North Somerset and part of Bath and North East Somerset.
They provide a range of services which include hospice at home, services in the community, a day hospice, a 24hr helpline, a spiritual care coordinator and an in-patient unit. As well as the work they do with patients and families they have an education centre with trainers who work with those who advise and care for patients away from St Peter’s Hospice such as GPs and care home workers.
When we visited there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.
The people who used the service and their relatives were full of praise for the highly considerate and personalised and professional approach of staff. Patients felt they were listened to and that their needs and requests were acted upon in a way that made them feel they mattered.
Staff we spoke with and observed were sensitive to the emotional needs of patients and offered appropriate and effective support as needed.
In consultation with patients the inpatient unit of nurses and a consultant led team of doctors worked together in the care planning process to provide specialist, intensive symptom control for patients. Depending on the specific risks and needs of the patient the care planning process was updated regularly, in many cases daily. The information was documented and communicated to the team. This ensured the staff had the most up-to-date information relevant to the individual.
There were also various non-medical approaches to pain and symptom control. Staff explained these were not an alternative to medical care but an enhancement of care whereby complementary therapies worked alongside medical treatments. These included emotional and spiritual support, developing coping strategies, relaxation and distraction techniques.
In some cases it was agreed by the patient that advance care planning would be appropriate. This process involved discussions between a patient and their health care professionals about future needs. The discussions established the patient’s priorities regarding their end of life care and enabled them to plan their future and prepare for their death whilst maintaining control over their wishes and preferences.
Staff we spoke with felt well supported in their role by the registered manager. There was an emphasis on support and an open dialogue was encouraged.
The service placed a strong emphasis on education of its staff and to other health professionals who cared for dying people in other settings, such as the community. The Education Department is an established centre for the provision of palliative care (management of pain and other aspects of long term illness) education. They provide education that is aimed at developing clinical practice and to improve care.
We identified that there were robust support arrangements in place which monitored and reviewed members of staff involved in delivering care, treatment and support in end of life care.
We found the service worked with key organisations, including the local authority and the national charity, Help the Hospices, to support local and national hospice care provision and service development.
Where people did not have the mental capacity to make their own decisions there was a process to be followed in considering a patient’s best interests. Staff we spoke with told us they practised best interest’s decisions for those people who did not have capacity. All clinical staff had received training in the Mental Capacity Act 2005.
We found the service was currently meeting the requirements of the Deprivation of Liberty Safeguards.