We carried out a review of the data available to us about St Giles Hospice - Whittington on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about St Giles Hospice - Whittington, you can give feedback on this service.
St Giles Hospice - Whittington is operated by St Giles Hospice and opened in Whittington in 1983. The hospice/service provides care for adults and has 25 beds.
The hospice at Whittington offers the following services:
25 inpatient beds – 19 for specialist palliative care needs and six for patient’s funded by fast track continuing healthcare funding who are less complex in terms of their end of life care needs and who would not usually therefore meet the criteria for specialist care.
Community team – a registered nursing workforce structured around localities which includes advanced nurse practitioners, clinical nurse specialists and staff nurses.
Hospice at home – led by a registered nurse this team of health care assistants provide practical and emotional care in the home for patients in approximately the last two weeks of life.
Care at home – a small team of carers who can provide up to four double up social care packages for people in receipt of fast track continuing healthcare funding.
Day hospice – patients attend for one day per week for eight or 12 weeks. Service operates four days per week. They work with their nominated nurse on personal goal setting and advance care planning as well as benefitting from peer support and reduction in social isolation. There is access to seated exercise and complementary therapy.
Wellbeing day – One day per week ‘step in’ or ‘step out’ service for people to find out more about services, seek advice or information, attend seated exercise or access complementary therapy; benefit from peer support.
Family support and bereavement - pre and post bereavement support offered at a variety of levels of intervention, either on a one to one basis, group or family based.
Advice and referral centre operates 24 hours a day seven days a week, advice for any professionals, patients known to St Giles Hospice or members of the public. Receives and triages referrals including speaking directly with person referred.
Supportive care – broad based team operating internally and externally that includes allied health care professionals; complementary therapy; community engagement and development work.
Lymphoedema - clinic service providing assessment and treatment for all forms of primary and secondary lymphoedema for both adults and children.
Phoenix service - bereavement service developed by and for young people experiencing bereavement and open to anyone across our catchment.
Specialist women’s cancer support service.
Care home Service - a fully commissioned service which supports individual care homes develop and maintain their end of life care registers and proactively plan and manage end of life care for their residents.
In May 2017, the hospice provider launched its new five-year strategy and as part of this underwent a re-brand.
We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 7 and 8 March 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 service improved. We rated it as Outstanding overall.
We found areas of outstanding practice:
We found good practice:
However:
Heidi Smoult
St Giles Hospice has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered provider, they are ‘registered persons.’ Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.
St Giles Hospice is an independent registered charity that provides specialist medical, nursing care and treatment, health diagnosis and screening; associated with specialist palliative and end of life care for people with life limiting, progressive and advanced disease or illness. The service includes a 27 bedded inpatient unit with an on-site advice and referral centre, a day hospice with on-site lymphoedema clinic and outreach service; a hospice at home service, which also supports people who may choose, to die at home. A range of other care and support services are offered for people and their families, which include bereavement and counselling, spiritual care, occupational, physio and alternative therapies, community engagement support and a transport service.
At the time of our inspection there were approximately 1380 people using the service, including 21 people accommodated on the inpatient unit at St Giles Hospice.
People felt safe and in control of their care and treatment. People’s care, treatment and medicines were consistently accounted for and safely managed. Risks to people’s safety associated with their health condition, environment or care equipment were fully accounted for. Staff understood and followed people’s care plans, which showed the care actions required to mitigate any identified risks to people’s safety from this.
People were protected from harm or abuse. People felt safe and both they and staff were confident and knew how to raise any concerns about people’s care and safety. Staffing and emergency planning measures helped to ensure that people received safe care. Equipment, environmental maintenance and cleanliness, was consistently maintained. This helped ensure people’s safety in care.
People and their families were highly satisfied and complimentary of the individualised care, treatment and support provided; and felt this made a positive difference to their health and emotional wellbeing. People’s care and treatment was consistently delivered in a way that met with their needs and wishes and often exceeded their expectations. Staff and volunteers worked as a cohesive team in consultation with external health professionals when required; to optimise people’s care and treatment options and their health and comfort. Plans to establish revised outcome measures for people’s clinical care and treatment from recent national guidance, aimed to further this.
The provider’s arrangements for staff training, development and support were comprehensive, well-resourced and service specific. This enabled effective clinical leadership, staff expertise and knowledge concerned with people’s palliative and end of life care and treatment.
Staff understood the importance of ensuring people received good nutrition and hydration; and the related support requirements at people’s life end stage of care. People accommodated on the inpatient unit were provided with quality and choice of food and drinks at times to suit them.
Staff understood and followed the Mental Capacity Act 2005 to obtain people’s consent or appropriate authorisation for their care. Manager’s checked the related assessment and decision making process to ensure this was being properly followed. This enabled people’s rights in care and helped to protect them from receiving end of life care that did not meet with their needs, wishes or best interests.
People received care from kind, caring and compassionate staff and volunteers who treated them with respect and were highly motivated to provide good quality care. Staff understood the importance of establishing good relationships with people and their families and took time to ensure people’s dignity, rights and involvement in their care. Policy and related staff practice aimed to ensure people received sensitive and dignified care following death. People and their families were treated as equal partners in their care, which was regularly reviewed with them. A range of care awards and good practice initiatives, demonstrated a caring organisation.
People, their families and members of the wider community were informed and supported to understand and access relevant care, treatment and support options available to them. Twenty four hour timely advice, support and appropriate care referral helped to ensure this when required. People’s relatives and staff had access to bereavement counselling and emotional support following a person’s death for as long as they needed it. This helped to ensure that staff, people using the service, those that mattered to them and the wider community received the information and support they needed.
Staff were attentive to and mindful of the detail of people’s lives, how their illness affected them and what was important for their care and treatment. Timely pain relief, symptom control and emotional support were well assured and central to people’s care provision. When people received life end stage care, they received this in private, with their families as they wished.
Staff understood and followed people’s decisions, wishes and preferences for their care and treatment. Related record keeping and information sharing systems helped to ensure this. Measures for continuous service improvement promoted people’s timely assessment, referral and involvement in decisions about their care and treatment. Strategic planning meant the provider engaged closely with the local community to build links, services and support networks to help shape, inform and support palliative and end of life care.
The provider had robust systems to report, review and learn from complaints and adverse feedback. People and their families were routinely consulted about their care experiences and knew how to raise any related concerns or complaints. Feedback obtained from this was used to inform and make service improvements when required.
People, their families, staff, volunteers and key stakeholders were confident the service was well managed and run. All said they would recommend the service to friends and family. Staff and volunteers described an open, positive culture where they were proud to work, valued and felt they made a real difference to people’s care. All were consulted and involved in way that helped to inform people’s care and treatment provision, service operation and improvement.
Senior leadership was visible, strong and supportive. Defined management and clinical governance arrangements ensured clear lines of authority, communication and decision making for the management of the hospice service and people’s care and treatment. Staff and volunteers understood their roles and responsibilities for people’s care, treatment and support. They were confident and knew how to report any related concerns or observed changes to people’s health, care or safety needs.
The provider operated comprehensive systems to regularly check the quality and safety of people’s care and treatment, which they regularly reviewed against relevant recognised national guidance concerned with this. The service management and reporting culture helped to ensure open, critical care review and learning from any serious care incidents. The provider had notified us of any important events that occurred at the service when required. This meant the hospice board and managers knew about and took responsibility for things that happened in the service, to safeguard people from harm.
Service planning took account of local population demands, financial viability and work force planning considerations. Partnership working and links with key external organisations, educational providers and care authorities; helped to support and inform people’s care and treatment provision, staff and service development and joined up care. Cross sector working, sharing of good practice, together with relevant local and national service development initiatives, were consistently sought and followed. This helped to inform and ensure the quality and shape of people’s care.
We found care was planned and delivered to keep people safe and which promoted their wellbeing as far as was possible. One of the relatives we spoke with told us: 'This is a wonderful place to be'.
We saw that the service took appropriate steps to minimise and reduce the risk of infection. Hand gel was available in all reception areas, and at frequent intervals along corridors in clinical areas.
We found that all medicines were securely stored and that systems were in place to ensure that these were ordered and dispensed appropriately. We also met with the hospice pharmacist.
We saw evidence that recruitment processes for all staff, including volunteers, ensured that only people of suitable character were employed by the service. We saw that staff were offered tailored induction packages as part of the recruitment process.
There was information about how to raise a concern or complaint in every hospice care booklet, and a dedicated complaints leaflet. We also saw a comments and suggestions box clearly available with postcards in the reception area.
We saw that people's care plans were personalised and detailed. They included information about people's own priorities and preferences in respect of their care and treatment. People told us their care was, 'Brilliant'. Relatives told us, 'They always find time to reassure us'. People told us they felt safe at St Giles Hospice.
Staff we spoke with told us about their high level of job satisfaction. They said they felt well supported by their managers and teams. They described the range of training available to them which enabled them to develop their knowledge of caring for people with a life limiting illness.
We found that St Giles Hospice had thorough systems in place to monitor the quality of the care and treatment provided. We saw that there was continuous monitoring of people's views about their care. We saw evidence that suggestions people made were acted upon. Any complaints or adverse comments were responded to. Most people who used the service and their families were very positive about every aspect of their experience.
People we spoke with and their carers talked enthusiastically about the care and the support they received in all areas of the service. People told us that staff were helpful and supportive and spent time explaining information to them. Comments included, 'They're absolutely wonderful to me, nothing is too much trouble', "They're so helpful and you can ask them for anything', 'They're attitude is so lovely', 'They explain everything to you', and I don't know what I'd do without them, I didn't know where to go or what to do before I came here.'
People valued the continuity of care and having a named person to speak to, people told us, 'At hospitals we always see different doctors, but at St Giles you get continuity' and 'I can ring at any time to speak, and if [the named nurse] isn't there is someone else I know and who knows me.'
People told us they contributed to the plan of care and staff asked them how they wanted to be supported. People knew this information was recorded and people we spoke with were content for staff to manage the plans. Carers told us they were included in discussions and one person stated 'They care about the carers, not just the patient'. Carers told us they knew who to contact and having access to volunteers or other support groups helped them to cope with difficult situations.