You are here

Willowbrook Hospice Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 11 February 2020

Willowbrook Hospice is operated by Willowbrook Hospice. The hospice accepts palliative adult patients aged 17 years and above from across the St Helens and Knowsley areas for complex symptom control and pain management, and end of life care. It has 12 inpatient beds across two wards, Oak Suite and Willow Suite.

The hospice offers 66 day therapy places and 20 medical outpatient clinic appointments per week in its dedicated wellbeing services unit, the Cedarwood Centre.

The hospice operates specialist palliative care telephone advice line 24 hours a day, seven days a week. A bereavement support service ‘Willowbrook Connections’ provides anticipatory bereavement support to patients and families.

We last inspected this hospice in August 2016 and the report was published in September 2016. We previously rated the hospice as good.

We carried out this short-announced inspection on 11 December 2019 and 19 December 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

Our rating of this hospice improved. We rated it as outstanding overall.

  • The hospice truly respected and valued patients, families and carers as individuals who were empowered as active partners in their care, practically and emotionally, by an exceptional and distinctive service. Staff were highly motivated to treat their patients with compassion and kindness, respected their privacy and dignity, always took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The hospice’s services were planned and tailored to meet the complex needs of individual people, and the local population, in partnership with the wider health economy. The hospice’s services were delivered flexibly, by a responsive and passionate multidisciplinary team, providing choice and continuity of care for patients, their families and carers. The hospice planned and worked to improve awareness and access to palliative care for hard to reach communities. The service made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • The hospice had enough staff to care for patients and keep them safe. Most staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They mostly managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

We found areas of outstanding practice:

  • The hospice is involved in a working partnership with the Pain and Anaesthetic Service. We were given information about a patient who had benefited from this service, where the anaesthetic team from the acute hospital had attended the hospice to administer an anaesthetic to ease discomfort while dressings were changed, and a more appropriate mattress was put in place.
  • The hospice had also recently linked with two other hospices in the locality to hold collaborative medicines management group meetings. The aim of this is to share learning and good practice within the group.
  • The hospice had achieved the European certificate in holistic dementia care.

We found areas of practice that require improvement:

  • Safeguarding vulnerable children level two training rates were low across nursing, medical and allied health professional staff groups.
  • Basic life support training completion rates for healthcare assistants was low at 64%.
  • The fluid used to dilute medicines for the syringe pumps was not always specified by the prescriber and the time frame for administration was not specified as part of the prescription.
  • Documentation of who had recorded the increase in dosages of medicines in the syringe pump was unclear on the medication chart, although a contemporaneous record had been made in the electronic clinical notes.

Following this inspection, we told the hospice that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals (North)

Inspection areas

Safe

Good

Updated 11 February 2020

Our rating of safe stayed the same. We rated it as

Good

because:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection and when transporting patients after death. They kept equipment and the premises visibly clean.
  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Risk assessments considered patients who were deteriorating and in the last days or hours of their life.
  • The hospice had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.
  • The hospice had enough medical staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix and gave locum staff a full induction.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
  • The service used systems and processes to safely prescribe, administer, record and store medicines.
  • The service managed patient safety incidents well. Staff recognised incidents and near misses and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
  • The hospice used monitoring results well to improve safety. Staff collected safety information and shared it with staff, patients and visitors.

However, we also found the following issues that the service provider needs to improve:

  • The service provided mandatory training in key skills to all staff and made sure staff completed it. However, basic life support training completion rates for health care assistants were low at 64%.
  • Safeguarding vulnerable children level two training rates were low across nursing, medical and allied health professional staff groups.
  • The fluid used to dilute medicines for the syringe pumps was not always specified by the prescriber and the time frame for administration was not specified as part of the prescription.
  • Documentation of who had recorded the increase in dosages of medicines in the syringe pump was unclear on the medication chart, although a contemporaneous record had been made in the electronic clinical notes.

Effective

Good

Updated 11 February 2020

Our rating of effective stayed the same. We rated it as

Good

because:

  • The service provided care and treatment based on national guidance and best practice. Managers checked to make sure staff followed guidance.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other needs.
  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.
  • Key services were available seven days a week to support timely patient care.
  • Staff gave patients practical support to help them live well until they died.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

Caring

Outstanding

Updated 11 February 2020

Our rating of caring improved. We rated it as

Outstanding

because:

  • There was a strong, visible person-centred culture that was promoted by the hospice’s leaders. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. Staff always treated patients and relatives with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to patients, families and carers to minimise their distress. Staff recognised and respected the totality of people’s needs. They always took people’s personal, cultural, social and religious needs into account, and found innovative ways to meet them. People’s emotional and social needs were seen as being as important as their physical needs.
  • Staff saw people, who were approaching end of life, and those close to them as active partners in their care. Staff were fully committed to working in partnership with patients, their carers and their families, and with ward staff to make this a reality for each person.
  • Staff and volunteers throughout the hospice and its wider services were passionate about meeting patients’ needs. This was part of the day to day provision of palliative and end of life care in the hospice such that outstanding care had become the expected standard.

Responsive

Outstanding

Updated 11 February 2020

Our rating of responsive improved. We rated it as

Outstanding

because:

  • The hospice’s services were delivered flexibly, by a responsive and passionate multidisciplinary team, providing choice and continuity of care for patients, their families and carers.
  • The hospice proactively planned its services and provided care in a way that took into account, and met, the preferences and needs of local people and the communities it served.
  • The hospice worked with others in the wider system and local organisations to plan care that promoted equality, including for those with protected characteristics.
  • The hospice planned and worked to improve awareness and access to palliative care for hard to reach communities.

  • The hospice put people’s individual needs and preferences central to the delivery of its services. The service was inclusive and tailored its care to individual patient needs. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.
  • Patients could access the specialist palliative care service in a way and at a time when they needed it. Waiting times from referral to achievement of preferred place of care and death were in line with good practice. There were processes in place to ensure urgent admission and rapid discharge when needed.
  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, comprehensively investigated them and shared lessons learned with all staff and other agencies where applicable. The service consistently included patients and their carers and families in the investigation of their complaint and could demonstrate how improvements had been made.

Well-led

Good

Updated 11 February 2020

Our rating of well-led stayed the same. We rated it as

Good

because:

  • Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.
  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.
  • Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.
  • The service collected reliable data and analysed it. Staff could find most of the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.
  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation.
Checks on specific services

Hospice services for adults

Outstanding

Updated 11 February 2020

The hospice supported palliative and end of life care services to people in the Knowsley and St Helens areas. The hospice has 12 inpatient beds for patients admitted for complex pain, symptom control, or end of life care. It has a dedicated wellbeing centre providing day hospice services and medical outpatient clinics.

We rated the service as outstanding overall. This was because all the hospice’s staff and multidisciplinary team were passionate to deliver individualised, safe care to patients living with complex symptoms and life-limiting conditions. Compassion was truly embedded in the hospice which supported people’s emotional as well as physical needs. Staff were highly motivated to respond to patients’ individual needs as well as those in the local area. The hospice was led by a strong effective executive leadership team, who had a strong vision and strategy for the service that promoted an inclusive culture and engagement with staff, patients, carers and the wider community.