Dorothy House Hospice Care

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At our last assessment we rated this key question outstanding. At this assessment the rating has remained outstanding.This meant people were truly respected and valued as individuals and empowered as partners in their care in an exceptional service.

This service scored 100 (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 an exceptional standard. The service was exceptional at treating people with kindness, empathy and compassion and in how they respected people’s privacy and dignity. Staff always treated colleagues from other organisations in a respectable way.

Staff were consistently respectful to patients demonstrating empathy and compassion in all interactions we observed. Staff were warm and caring, listening carefully to what people had to say about their experience and demonstrating understanding of individuals’ different circumstances. For example, staff identified people who were attending the day service for the first time and offered additional support and reassurance so they felt at ease in the group discussion. Staff gave people time to speak and share their thoughts, validating people’s contributions. As a result of staff’s approach, the activity resulted in shared humour and laughter, providing a safe environment in which people could learn from each other and openly discuss their experience.

Feedback from patients and their relatives reflected how staff’s kindness, empathy and compassion made a difference to their experience of care. One patient we spoke with described staff as “so sympathetic, so kind, so understanding…you can tell them your worries and they say, “We’ll do something about it” while another patient told us that sessions had been “a joy to attend” enabling them to feel understood and less isolated as a result of their illness. Feedback received by the service from patients and their relatives included how the service had treated them “with respect and a deep kindness…every member of staff showed a great deal of empathy and compassion throughout” while another described how “everyone went over and above” in spending time with them and caring about their worries. Other people’s comments noted how staff had gone “the extra mile” and “could not have been kinder”. Staff spoke about patients with respect and sensitivity describing the privilege they felt in being able to make a difference to people receiving palliative and end of life care and their commitment to Dorothy House’s vision that no-one should face death alone.

Care provided by staff promoted people’s dignity, enabling them to talk about their experience and what they needed from their care. For example, we observed staff enabling a patient to describe how their condition was impacting on their wellbeing which ensured they could be offered appropriate support to meet their needs. We also saw staff showing respect for patients’ complex personal circumstances and action taken to ensure people received compassionate, non-discriminatory care. This included interventions by the homeless link worker whose role focused on meeting the needs of people in vulnerable situations and raising awareness of support available from Dorothy House in relation to palliative and end of life care. They gave us examples of the additional practical support they provided to people, and their relatives, at risk of homelessness such as support with maintaining tenancies or relocating to suitable alternative accommodation, working closely with other organisations to achieve this. This helped ensure that people, regardless of their personal circumstances, benefited from compassionate care which met their needs and respected their dignity as part of their local community. Staff we spoke with described how ensuring everyone felt welcome at Dorothy House was an important part of care, this being reflected in comments received by patients who described how they had been made to feel respected, comfortable and welcome.

There were various rooms in the hospice which could be used to have private conversations and we saw evidence of people’s privacy and dignity being promoted with doors closed during conversations and staff articulating their responsibilities to uphold patients’ rights and wishes.

The evidence showed an exceptional standard. The service treated people as individuals and was exceptional in how they made sure people’s care, support and treatment met people’s needs and preferences. The service took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

People, and their families, received care and support which centred on their individual strengths, needs and choices. We saw that people were given options to access support services that aligned with their personal preferences and enabled them to express themselves in ways that were meaningful to them. For example, the creative therapies team described how they offered opportunities to people to participate in arts and crafts as a way for people to engage in activity while enjoying companionship. We observed a crafts session taking place noting people’s engagement and pleasure in being productive. One person described how the activity “made them feel useful” while another described how group activities offered by the hospice provided them with opportunities to “be with people who understand”.

A dedicated spiritual support team, comprising staff and volunteers from different faith and no faith backgrounds, was available for patients who wished to access spiritual care either individually or in a group. Staff described how they worked alongside different faith or non-faith organisations to ensure people received appropriate support but could also work independently with people for whom spirituality was a unique, personal, journey. Psychological and emotional support was also available through the hospice, staff recognising that flexibility in where, when and how, they delivered care was important in providing a personalised approach. For example, staff recognised that some people required additional emotional support coming to terms with their diagnosis while others benefited from increased support at end of life. It was also recognised that individuals had preferences in relation to one to one or group support with alternatives being offered both at the hospice and in the community for different age groups and tailored to people’s different needs. Staff told us, “whatever we do, we bring it back to the patient” and described how the family support team had been “very good, very obliging” in responding to requests so that people receiving care, and their families, could connect with someone offering suitable support in a timely way. Feedback received by the service from patients and their relatives indicated how “adjustments were made to accommodate seamless sessions” and the service had provided support “beyond what I could have hoped for during a very difficult time.” This ensured that patients and their relatives were treated as individuals and received the psychological, emotional and spiritual care they needed in a way that was meaningful to them.

Treating people as individuals was embedded in the hospice’s practice. Staff emphasised the importance of a holistic approach which took into account people’s physical, mental, emotional and spiritual needs and enabled people to prioritise what was important to them. For example, staff were able to provide practical support with housing which helped people make the transition between community and inpatient care and enabled people to engage more readily in treatment. Other patients wanted to fulfil goals such as enjoy a final family holiday despite their frailty, celebrate special occasions or have family, including their pets, with them during their stay. Staff told us, “personalised care is our norm” and gave us examples of how they had worked with people to arrange meaningful experiences which provided them, and their families, with lasting positive memories. This included, for example, working with relatives to bring a Royal Marines band to the hospice to play for a patient in the armed forces. Staff also helped make technology available to livestream a family wedding so the patient and their friends could celebrate the occasion from the hospice when the patient was unable to attend in person. These examples brought comfort to families, with feedback reflecting their gratitude and how staff had shown “unbelievable dedication” in enabling their relative to fulfil their final wishes.

Staff were clear about their responsibility to deliver inclusive care by responding to people’s different needs in line with Dorothy House’s equality, diversity and inclusivity strategy. For example, they described how they had welcomed and recognised the needs of a patient whose gender identity differed from the sex they were registered with at birth. Their needs had been met by staff using their preferred pronouns and the name they wished to be known by and making sure their choice of clothing was respected.

The hospice had processes for identifying needs in response to people’s disabilities and learning differences with staff showing confidence in making appropriate adjustments. We also heard how staff were engaging with individuals from hard-to-reach groups such as travelling and boating communities recognising their specific challenges in accessing information and care services and liaising with agencies who had established relationships with these groups. Equally, staff told us that some patients did not want to engage in conversations about their care which was also respected.

The evidence showed an exceptional standard. The service was exceptional at promoting people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

People benefited from staff who worked with them to maintain their independence and autonomy. For example, we observed a group taking place in the hospice’s day service where people were given information and guidance about preventing falls and keeping safe at home. Staff provided guidance about community support services such as lifeline services and mobility equipment and people were encouraged to think about things they could do to improve their quality of life. One participant told us they valued these sessions as it gave them information they could use to solve problems and overcome challenges: “there are simple things I can do…it helps me to think things out”. Feedback from another patient who was receiving support from the physiotherapy team indicated how staff had encouraged them to be an active participant in their own rehabilitation. This enhanced their enjoyment of sessions and provided them with hope, confidence and motivation for the future. As a result, the hospice ensured people had the information and support they needed to maintain their independence and quality of life while providing opportunities to develop new skills.

People were given choices about their care. For example, patients were able to make choices about items they wished to bring from home, such as pictures and photographs, to promote their comfort. Patients were also able to make choices about what they ate; we spoke with one patient who told us they had been able to discuss their preferences with the chef which meant they could enjoy their meals.

People staying on the inpatient unit could choose who visited them and when they wanted to receive visitors. We observed visitors spending time with patients throughout our visit and staff told us they were able to come and go as they wished. This included opportunities for people to stay overnight which was facilitated by recliner chairs, camp beds and access to drinks, cereal, toast and shower facilities. Staff viewed their role as gatekeepers, advocating for patients to ensure their wishes were followed. This gave patients control over their stay.

Staff promoted patients’ choice and control by ensuring people’s voice was central to their care. We saw evidence of the team ensuring the patient’s voice could be heard within their family and by other agencies, highlighting concerns where there was a potential risk to people’s involvement. Staff also described circumstances where they had intervened to ensure patients’ choices were represented in multi-agency discussions and their rights were upheld. This was also reflected in patients’ feedback to the service where one patient, for example, described how the service had enabled them to ‘find their voice’ while others noted they had been included in all decision-making and had felt their input was valued.

Dorothy House had a family support team which provided support to people experiencing loss and bereavement and offered options in how this was delivered. This included offers of individual support and group support such as community support groups, practical courses, meet-ups over coffee and interest-based groups. These took account of people’s different needs according to their age and family relationships. This gave people choices in relation to when, how and where they wanted to access support, recognising the unique experience of people affected by bereavement.

The evidence showed an exceptional standard. The service was exceptional in how they listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

We observed support being provided to people using the service in a way that noticed and responded to their immediate needs. For example, staff noticed that a person’s hearing aids were not working which impacted on their participation in a group session. Staff responded immediately by sitting next to them, making eye contact and taking time to explain what was happening. Staff also gave the patient a booklet to read which meant they could follow and join in the group discussion. We saw feedback from another patient which praised the way staff listened to and understood their needs by adapting their physiotherapy programme to how they were feeling on the day. This meant that people’s needs were met by staff who responded to people in the moment ensuring concerns were addressed and they could participate in their care.

We observed detailed discussion within the multi-disciplinary team, and with other care providers, about patients’ needs and how Dorothy House could offer support. This included how the team could help people in the event of their deterioration or emerging risks to their care. For example, we saw arrangements made to review a patient’s daily living needs, and the needs of their family, to ensure they could live comfortably at home. Where patients wanted their family to be involved in their care, this was included in planning discussions and we saw an example of the team supporting a family to meet their relative’s eating and drinking needs. By using the team’s expertise in identifying people’s immediate and anticipated care needs, action was taken to meet their needs in a timely way.

Staff described how they adapted their approach to patients’ needs as they transferred between community, day patient and inpatient settings and approached end of life. This included ensuring patients and their families were supported with practical issues such as housing and financial arrangements. It also included staff being responsive to people’s emotional and spiritual needs such as arranging baptism or hand-tying ceremonies at short notice. We heard several examples of how the team had listened and intervened to ensure people’s wishes were met. For example, staff made arrangements to bring Christmas festivities forward for a patient who wanted to spend a final Christmas with their family. This enabled them to enjoy music and films that had special meaning for them. Staff had also taken action to meet a patient’s wish to die outside, surrounded by nature. Responding to people’s needs in a timely way ensured that people’s needs were met at end of life and families were left with positive memories of time spent with their loved ones.

The evidence showed an exceptional standard. The service always cared about and promoted the wellbeing of their staff and was exceptional at supporting and enabling staff to always deliver person-centred care.

Staff and volunteers told us they felt valued and included by the service whatever their role. They spoke with pride about the part they played in caring for patients and their ability to influence service development by suggesting improvements and working as a team. For example, staff working in the family support team described how psychological, spiritual and emotional support was treated as an integral part of people’s care. They told us they were actively involved, as equal partners, in team discussions and their contributions were valued and acted upon. A volunteer described how they were treated as an important part of the workforce and included in new initiatives and incentives which helped them feel they belonged and were valued by the organisation: “I feel like I’ve come home…I love it here.”

There was support available for staff to promote their health and wellbeing. This included access to an occupational health service and a 24 hour assistance helpline which provided confidential support options including counselling and financial advice. Staff described how they had been supported by managers to manage their health and wellbeing needs. This enabled them to continue working with adjustments to their role where required. A member of staff told us, “Dorothy House has been fantastic in facilitating this…I felt held by the organisation” while another member of staff commented on how the senior leadership team had checked in with them during a personally challenging period: “The team are so responsive and aware…we are able to talk with managers about issues. If you need time off, it is given, not questioned”.

Staff were able to access confidential spiritual support from within Dorothy House. This was available on an individual basis or through participation in a group, alongside patients and their families, which included opportunities for meditation, poetry and music. This embraced an inclusive approach in which staff, patients and their families could sit together and engage in shared reflection and mutual support for the human experience of loss and grief. Feedback received from staff included: “I’ve never not had support if I’ve needed it”; “Great managers…I feel confident to ask for support, I know I will get it” and “There is so much care from the organisation”. We saw evidence that Dorothy House had recently renewed their commitment to the Mindful Employer Charter, a national initiative which supports employers to take a positive approach towards mental health at work. Feedback received about their submission commented on their proactive approach to supporting employee wellbeing with reactive support being available as required, this being consistent with recommended practice.

There were processes in place to provide supervision, debrief and peer support for staff which recognised the unique challenges of providing end of life care. Staff told us they felt able to ask for a debrief in response to incidents and, where external specialist supervision was identified as being of benefit to staff, this had been arranged. Staff described how robust and compassionate multi-disciplinary discussion enabled team consensus on delivering care in complex circumstances, for example working with patients who required staff support to smoke or who did not want to be offered food. This resulted in staff feeling supported in providing care which might challenge their professional or personal values while ensuring patients’ rights were upheld and care was truly patient-centred. Teamwork was valued across the organisation with staff telling us they were encouraged to contribute their views, offer different perspectives and advocate for patients’ wishes. This collaborative approach equipped staff with the skills and confidence to support people and their families in challenging circumstances and enabled them to deliver exceptional personalised care.

There were arrangements in place to ensure staff felt safe and secure at work. Security arrangements ensured patients and staff were safe at all times of the day and night with appropriate parking facilities available for staff. Staff described how they felt able to perform to the best of their ability with the organisation’s support and were motivated to contribute to improvements that benefited the whole Dorothy House community. This aligned with the organisation’s workforce strategy on nurturing staff wellbeing and resilience as a priority in future service development.