Hospice at Home West Cumbria

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 looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We looked at 4 care records during the assessment, held electronically.

All referrals were triaged by a senior hospice nurse, and care and support needs were discussed with the patient and their family and carers. Consent was gained prior to accepting a referral to enable information to be shared with those involved in care provision.

Where possible, senior hospice staff completed a face-to-face assessment, individualised care plans and risk assessments prior to staff deployment. If this was not possible a hospice nurse completed the care plans and assessments during their shift.

Staff followed guidelines for patient referral and ongoing care, which supported the allocation of staff according to patient needs. This included the phase of illness and the Karnofsky score to establish where possible, the amount of care required.

Care plans were discussed at shift handover and electronic templates updated as required by the nurses and appropriately trained health care assistants.

The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Managers we spoke with explained that some clinical policies were adapted from those used in the local NHS trust, so that practices were aligned and consistent. However, the infection prevention and control policy we saw was not service specific and some of the content was not relevant to the service. For example, it was not adapted, version controlled and ratified in accordance with local governance procedures. It alluded to, for example, aerosol generating procedures, which were not undertaken at the service, and outlined management of linen and laundry in the trust setting. This policy was not included in the master policy index.

However, all other policies we looked at were up to date, ratified and referenced best practice guidance. Team leaders had accountability for policy updates and there was a schedule in place. Staff were prompted to read new policies at team meetings and accessed them online, via the staff access facility on the service’s website.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. For example, there was a structured programme of internal audits for the year. These monitored compliance against policy, for example, record keeping. In addition, the service participated in the National Audit of Care at the End of Life (NACEL). This was a national comparative audit of the quality and outcomes of care experienced by the dying person and those important to them during the last admission leading to death.

Managers we spoke with told us about improvements due to audit outcomes. For example, records audit highlighted that spirituality was not always recorded in sufficient detail, so the staff received spirituality training to enable better understanding of what spirituality means to patients and their carers. Completion compliance improved following this training.

Teams ensured they kept up to date and attended professional forums, such as Hospice UK events and British Lymphoedema Society meetings.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. They ensured staff received the necessary specialist training for their roles.

Managers dealt with poor staff performance promptly and effectively.

The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

We observed how staff shared information about patients at effective shift to shift handover meetings within the team.

Handovers were documented using a template document to ensure a consistent approach. Team leaders told us that they also had full access to community colleague's electronic records, to enable teams to work together effectively to benefit their patients.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff supported patients to live healthier lives. For example, following holistic assessment, staff provided advice and information on nutrition and hydration, pain management and skin care. They discussed end of life systematic changes sensitively, with patients and their carers. Staff recognised when needs changed and tried to educate the family to manage expectations in a supportive way. The staff described it as a ‘’personalised model of care’’.

The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

As part of holistic assessment, staff discussed and recorded patients preferred place of care and preferred place of death. For example, while most people expressed a preference to die at home, staff were aware this could change with age, health, and approaching death, with some patients later preferring a hospice or hospital care. Staff were mindful that achieving a good death was about receiving high-quality, person-centered care, and not solely about the location itself.

Staff participated in data collection for national audits concerning the quality and outcomes of care experienced by the dying person and those important to them.

In addition, staff received Karnofsky tool training to assess patients’ functional ability and independence. The tool helped staff assess prognosis and monitor changes in a patient's condition.

Managers monitored the quality of record keeping and data capture through scheduled audits, which showed good compliance.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. When patients lacked capacity, for example, when unconscious, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.