St Richard's Hospice

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We rated effective as good

We assessed all 6 quality statements for effective, assessing needs, delivering evidenced based care and treatment, how staff, teams and services work together, supporting patients to live healthier lives, monitoring and improving outcomes and consent to care and treatment.

Staff followed a consistent and high-quality approach to assessing, and reviewing patients’ health, care, wellbeing, communication needs and their mental health needs.

The service planned and delivered patients’ care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Staff worked together and with others when assessing patients’ needs and shared information to maintain continuity of care.

Staff gave patients practical support and advice to improve the quality of their life and lead healthier lives.

Staff monitored patients’ care and treatment to continuously improve it.

Staff told patients about their rights around consent. Staff respected these rights when person-centred care and treatment was delivered.

At our last inspection we rated this key question good. At this inspection, the rating has remained good.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a consistent and high-quality approach to assessing, and reviewing patients’ health, care, wellbeing and communication needs with them. Patients’ individual needs were appropriately assessed, and staff ensured the care provided met their needs. The hospice used personalised care plans and goal setting and included both patient and their families in patients’ assessments. Staff actively encouraged patients to maintain their interests and participate in activities.

Staff assessed patients’ needs using a range of assessment tools to ensure their needs were identified and understood. Assessments considered patients’ health, care, wellbeing, and communication needs, to enable them to receive care or treatment that had the best possible outcomes.

There was a creative and person-centred approach in ensuring patients’ communication needs were met to maximise the effectiveness of their care and treatment. Staff told us they asked patients: "What matters to you” and they recorded their response on the electronic record to ensure everyone was aware of their wishes. Responses included “I want my pain to be controlled,” “Tell me, even the difficult things.” Patients and their loved ones participated in the assessment and staff provided support where needed to maximise their involvement.

All patients on the inpatient unit were reviewed by a doctor every day. There was also a consultant ward round Wednesdays and Fridays during which patient’s needs and treatment were reviewed.

Staff on the inpatient unit had daily handover meetings at the start of each shift so they knew if there had been changes in patients’ psychological and emotional needs, as well as their medical and nursing needs.

All staff, including those in the community and wellbeing services told us they worked as part of a multidisciplinary team to continuously assess the changing needs of patients.”

Staff assessed and discussed the needs of relatives and loved ones. This supported their health and wellbeing in their carer roles and helped them to provide safe and effective care to their loved ones they supported.

St Richard's Hospice had a proactive, systematic approach to managing safety. Leaders embedded, maintained and sought to continuously improve a culture of openness and collaboration, and safety was everyone’s top priority. Staff recognised and reported incidents and near misses and reported them appropriately.

Managers investigated incidents and shared lessons learned with the whole team. Patient safety incidents were also shared with partnership agencies working in end-of-life care so learning could be shared as widely as possible. When things went wrong, staff apologised and gave patients honest information and suitable support.

Clinical incident trend analyses were undertaken to proactively address themes and trends. This included pressure ulcers, safeguarding concerns and medication errors. The review highlighted most pressure ulcers were acquired before admission although the service proactively ensured pressure relieving mattresses were available on all inpatient beds and regular review of patients’ skin to avoid further skin deterioration.

Patients and staff, including volunteers, were actively encouraged and rewarded for raising concerns about safety and ideas to improve, and the value of learning is continually demonstrated and reinforced by leaders.

Managers and staff held monthly mortality meetings to review of all patient deaths. The meetings included a full review of each patient and their management by each professional group and the care and treatment provided. We saw these reviews identified both good practice and areas where improvement was needed. Key areas for improvement included review of mental capacity and the challenges of mouth care records identified within both paper and electronic records. Actions were identified for named staff following these meetings. A monthly action log from mortality meetings was created. Progress was monitored through the clinical quality management review meetings which looked at and identified any opportunities to learn.

Staff had access to the information they needed to appropriately assess, plan and deliver patients’ care, treatment and support. The whole staff team worked collaboratively to make sure patients' healthcare needs were met. The team included medical and nursing staff, nursing assistants, occupational therapists, social workers, physiotherapists, complimentary therapists, administrative staff, and a range of other support staff.

The Hospice at home team worked in partnership with domiciliary care agencies, GPs, district nurses, and other community teams delivering care to patients in their homes.

The hospice provided telephone advice both in and out of hours for end of life or palliative care issues. This included providing support to other services and professionals, for example GPs, community nurses, hospital doctors, nurses, and paramedics. Feedback we received from other services positively identified the support hospice staff provided.

Staff assessed the suitability of patients for the Hospice at Home service. The assessment included looking at the needs of the person to understand if they could be met by the team or in conjunction with additional domiciliary care service providers or an alternative health care provider.

When patients were due to move between services, all necessary staff, teams and services participated in assessing their needs to maintain continuity of care.

The hospice staff worked with other health and social care providers to ensure patients complex palliative care needs were met.

There was a strong focus on empowering patients to manage their own health, care and wellbeing needs as much as possible. Patients (with their family and carers) participated in regularly reviewing their health and wellbeing needs to improve the quality of their life including their end of life care.

Services focused on identifying risks to patients’ health and wellbeing early to maximise their quality of life and including care at the end of their life. Patients were asked about their goals and what was important to them.

Patients and their loved ones could access information to improve the quality of life including managing breathlessness, tiredness and pain.

The hospice had staff available to support their psychological health.

Staff encouraged and supported patients to make healthier choices to promote and their health and wellbeing. There were health promotion materials throughout the service displayed on the walls, in the form of leaflets, helplines, and organisations to support ongoing health promotion.

Patients’ care and treatment was routinely monitored to continuously improve it. Patients told us their loved one’s needs were holistically considered and staff regularly checked with them about their care and treatment. Patients and their loved ones were given the opportunity to give feedback about the service during their care and after admission utilising electronic, written and verbal methods in the in-patient unit. This encouraged patients and their loved to tell the service how they felt about the support they received.

Outcomes were positive, consistent, and meet both clinical expectations and the expectations of patients themselves. The service used the Integrated Palliative care Outcome Scale (IPOS) as a measure of symptoms and concerns which matter to patients therefore helping staff provide the best patient experience. In addition, the service used Goal Attainment Score (GAS) to ensure patients had achieved desired goals.

Staff used recognised tools to monitor patients, for example the ‘Australia-modified Karnofsky Performance scale’ (AKPS) to assess patients' day-to-day functioning. This assisted in assessing if care needed to be adjusted as a patient neared the end of life.

Managers and staff completed audits to monitor and improve upon outcomes. Staff gave examples of actions, good practice and learning being shared with them. These included, tracheostomy (a breathing tube) audit, blood transfusion audit, consent, mouthcare and pressure ulcer audits.

The service monitored its performance and benchmarked itself against other local and regional hospice providers. Data included number of admissions, deaths and discharges, percentage occupancy and length of stay as well as average pressure injury risk score on admission, number of medication errors per 1000 bed days and the number of slips trips and falls were all monitored and benchmarked at clinical quality and management meetings.

Managers and staff presented a range of audit results to the audit and evaluation group. These included the Mental Capacity Act audit, notification of death and discharge summaries audit, communication needs audit, recognition of death audit and mouthcare audit. The meeting attendees checked for any changes to National Institute for Health and Care Excellence guidelines which included end of life and palliative care patients. The service audited care provision in terms of meeting patients' individual needs. To support this, electronic patient notes captured details of patients' protected characteristics and communication needs.

The service told patients about their rights around consent and respected these when delivering person-centred care and treatment. Staff supported patients to make informed decisions about their care and treatment. Staff followed national guidance to gain patients’ consent. Staff knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. When patients could not give consent, staff made decisions in their best interest, considering patients’ wishes, culture and traditions. This included following advance care plans that had previously been developed with input from the patient and those close to them.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Mental capacity assessments were carried out routinely as part of assessment processes across the hospice. Staff understood the principles of best interest decision making where patients were assessed as not having the mental capacity to make certain decisions. Where appropriate, family members and those close to the individual participated in discussions about decision.

Staff made sure patients consented to treatment based on all the information available and took time to ensure patients understood the information.

Practices around consent and records were actively monitored and reviewed to improve how patients were involved in making decisions about their care and treatment. Staff clearly recorded consent in the patients’ records. Records of consent were routinely audited six monthly and as part of a review of patients death and care provided to identify any gaps and improvements required.

Staff appropriately supported patients including families/carers understand the principles of the Mental Capacity Act and supported them to make decisions about their care.