• Hospice service

St Barnabas Hospice - Specialist Palliative Care Unit

Overall: Outstanding

36 Nettleham Road, Lincoln, Lincolnshire, LN2 1RE (01522) 511566

Provided and run by:
St Barnabas Hospice Trust (Lincolnshire)

All Inspections

5 May 2022

During a monthly review of our data

We carried out a review of the data available to us about St Barnabas Hospice - Specialist Palliative Care Unit on 5 May 2022. 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 Barnabas Hospice - Specialist Palliative Care Unit, you can give feedback on this service.

08 August 2019

During a routine inspection

St Barnabas Hospice is operated by St Barnabas Hospice Trust (Lincolnshire).

St Barnabas Hospice is a Specialist Palliative Care Unit which provides a wide range of services for adults who have advanced, progressive illnesses and where the focus is on palliative and end of life care. The services are provided within four settings; an eleven-bed in-patient unit, day therapy centres, hospice at home services and a palliative care co-ordination centre. Holistic services are delivered by a team of medical, nursing and social work staff, occupational and physiotherapists, counsellors, volunteers and chaplains.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service.

Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager had been in post at St Barnabas Hospice since 2015.

The service was registered to provide the one regulated activity of Treatment of disease, disorder or injury (TDDI) to people over the age of 18 years.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on the 08 August 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 because:

We found outstanding practice in relation to the hospice:

  • There was a very strong, patient-centred culture from all staff. Staff were motivated and inspired to offer care for patients with kindness, compassion, dignity and respect through supportive relationships with patients and their families, care givers and loved ones.

  • We observed all staff members speaking to patients and their relatives and care givers with compassion and we observed sensitivity being shown during those conversations.

  • We heard patients being offered food and drinks in an encouraging and caring way and observed staff and volunteers to always be doing as much as they could to help patients.

  • One of the patients told us, “The staff are all fantastic”. another patient told us. “I simply cannot fault them”. Another patient told us, “The care here is second to none”

  • Staff ensured that patients and those close to them were partners in decisions about their care and treatment. People’s individual needs and preferences are central to the delivery of tailored services.

  • There are innovative approaches to providing integrated person-centred pathways of care that involve other service providers, particularly for patients with multiple and complex needs. For example, at the time of our inspection, the hospice was delivering two projects to reach out to the homeless community and to a local prison, offering bereavement care to both communities. The projects included education to support staff to provide palliative care to those who do not normally have access hospice care counselling and provide bereavement counselling to the inmates of a local prison

  • The Hospice hosts the PCCC, a commissioned service, with a single point of access. The PCCC was available to health professionals, patients, their families and care givers who need advice and support regarding palliative and or end-of-life care

  • The PCCC centre facilitated referrals, organised care packages and worked in partnership with the clinical teams and the wider health community to enable care delivery within that community.

We found Good practice in relation to the hospice:

  • The service provides mandatory training in key skills to all staff and made sure everyone completed it.

  • Staff understand how to protect patients from abuse and the service works well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

  • The service-controls infection risk well. Staff keep equipment and the premises clean and used control measures to prevent the spread of infection.

  • The service has suitable premises and equipment and looks after them well.

  • Staff complete and update risk assessments for each patient. The records are clear and updated regularly

  • The service has 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.

  • Staff keep detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.

  • The service follows best practice when prescribing and giving medications and patients receive the right medication at the right dose at the right time

  • The service manages patient safety incidents well. Staff recognise incidents and reported them appropriately. Managers investigate incidents and share lessons learned with the whole team and the wider service. When things went wrong, staff apologise and give patients honest information and suitable support.

  • The service provides care and treatment based on national guidance and evidence of its effectiveness. Managers check to make sure staff follow guidance.

  • Staff give patients enough food and drink to meet their needs and improve their health. They use special feeding and hydration techniques when necessary. The service adjusts for patients’ religious, cultural and other preferences.

  • Staff assess and monitor patients regularly to see if they were in pain. They support those unable to communicate using suitable assessment tools and give additional pain relief to ease pain.

  • Managers monitor the effectiveness of care and treatment and use the findings to improve them. They compare local results with those of other services to learn from them.

  • The service make sure staff are competent for their roles. Managers appraise staff’s work performance and hold supervision meetings with them to provide support and monitor the effectiveness of the service.

  • Staff of different kinds work together as a team to benefit patients. Doctors, nurses and other healthcare professionals support each other to provide good care.

  • The service delivers a full inpatient service for patients receiving palliative care seven days a week.

  • Staff understand their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They know how to support patients experiencing mental ill health and those who lack capacity to make decisions about their care.

  • The service plan provides services in a way that meet the needs of local people.

  • The service takes account of patients’ individual needs.

  • People can access the service when they need it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients are in line with good practice.

  • The service treats concerns and complaints seriously, investigates them and learns lessons from the results, and shares these with all staff.

  • Managers at all levels have the right skills and abilities to run a service providing high-quality sustainable care.

  • The service has a vision for what it wants to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.

  • Managers across the service promote a positive culture that supports and values staff, creating a sense of common purpose based on shared values.

  • The service has effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected risks

  • The service collects, analyses, manages and uses information well to support all its activities, using secure electronic systems with security safeguards.

  • The service engages well with patients, staff, the public and local organisations to plan and manage appropriate services as well as collaborating with partner organisations effectively.

  • The service is committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation.

Services we rate

Our rating of this. We rated it as outstanding overall

  • Staff cared for patients with compassion, empathy and respect. Feedback from all patients confirmed that staff treated them exceptionally well and with kindness and told us that staff went over and above what was expected of them. People were truly respected and valued as individuals and empowered as partners in their care, practically and emotionally, by an exceptional and distinctive service.

  • The trust responded to people’s individual needs and preferences which were central to the delivery of tailored services. There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs. The services were flexible, provided informed choice and ensured continuity of care.

  • There was an embedded and extensive team of volunteers who helped support the service. There was a separate volunteer induction and training programme.  Volunteers were valued members of the service who were provided with support and who felt part of the hospice team.

We also found areas of good practice:

  • The service had enough staff to care for patients and keep them safe. 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 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. 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.

  • Staff treated patients with great compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided exceptional emotional support to patients, families and carers.

  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and 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.

  • 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.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central Region)

29 March 2016

During a routine inspection

We inspected St Barnabas Hospice – Specialist Palliative Care Unit on 29 March 2016. The inspection was unannounced. St Barnabas Hospice is a registered charity covering the county of Lincolnshire.

St Barnabas Hospice – Specialist Palliative Care Unit provides a wide range of services for people who have advanced, progressive illnesses and where the focus is on palliative and end of life care. The services are provided within four settings; an in-patient unit, a day therapy centre, hospice at home services and a palliative care co-ordination centre. Holistic services are delivered by a team of medical, nursing and social work staff, occupational and physiotherapists, counsellors, and chaplains.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of the inspection no-one using the services had any legal restrictions placed upon freedom. We saw that where this had been a necessary action prior to the inspection the provider had acted in accordance with legal guidance in order to protect people’s rights.

People were unanimously positive about the services they received from St Barnabas Hospice – Specialist Palliative Care Unit. Without exception they praised the staff for their personalised and caring approach.

People were the focus of and at the heart of the service. They were central to the planning and reviewing of their care packages and those who were important to them were fully consulted. Support for people’s spiritual, cultural and emotional needs was an integral part of their care package.

People privacy and dignity were respected in all of the hospice care settings. Their consent was sought before any care was provided. Their views and those of people who were important to them were respected and used to help improve the quality of the services people received.

Staff understood people’s needs, preferences and wishes and provided support that took all of these things into account. Staff were well trained and supported to provide care and treatment that was sensitive, warm and respectful. They were knowledgeable about their specialist field of care and took account of how a person’s wider medical needs impacted upon their life limiting diagnosis. They were supported to keep up to date with current good practice and research within their specialist field of care

People were supported to stay safe by staff who knew how to recognise and report signs of abuse. Staff also knew how to assess and manage risk in a way that did not limit a person’s lifestyle.

People received all of the healthcare support they required. Doctors and therapists who specialised in palliative and end of life care provided support alongside people’s GP, community nurses and NHS Trusts. People’s nutritional needs met in a personalised way that took account of their preferences and wishes.

People who used the service and those who were important to them praised the way the service was run. Effective leadership and management systems supported a culture of openness and close team working. There was a strong emphasis on providing care that was based on current good practice guidance and relevant research. There was also an emphasis on continuous service improvement which was supported by effective quality assurance systems, close liaison with partner agencies and the local community.

10 January 2014

During a routine inspection

One person spoken with told us that, "The staff are very kind and helpful and I cannot speak too highly of the care that l have received here.' This and the other evidence reviewed demonstrated to us that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Everyone spoken with told us that the meals provided were very good and that they could choose whatever they liked or fancied at each mealtime. This and the other evidence seen showed us that people were protected from the risks of inadequate nutrition and dehydration.

Those medicines administration records seen were completed appropriately and provided an audit trail of medicines in use. This demonstrated to us that people received their medicines as prescribed.

Staff spoken with told us they were well supported by senior staff and that systems were in place to provide ongoing clinical and professional support. This was particularly valued by staff due to the specific pressures of their professional role. This showed us that there were enough qualified, skilled and experienced staff to meet people's needs.

The records reviewed were accurate and were reviewed and updated regularly to reflect the delivery of specialised palliative care. This meant that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

3, 4 January 2013

During a routine inspection

We inspected the St Barnabas Hospice site at Lincoln. We visited the in-patient unit and the day therapy unit. We saw people received ongoing information about their care and treatment. One person we spoke with described how staff carefully explained everything to them and made sure they understood all their treatment and care options.

Patients and relatives expressed great satisfaction with the care and support they received at St. Barnabas Hospice. One person told us, 'The staff are brilliant, so experienced and supportive. My symptoms are managed much better now. The whole experience has exceeded my expectations.'

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 people were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People told us they felt safe at the hospice.

We saw the service had effective systems in place to monitor and improve the service. These systems involved consulting with people using and visiting the service. We found the service took a positive approach to receiving comments about the service and valued feedback from people to enable the service to be further developed.