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Princess Alice Hospice Outstanding

We are carrying out a review of quality at Princess Alice Hospice. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary

Overall summary & rating


Updated 8 November 2016

This inspection was carried out on 12, 13 and 27 September 2016 and was unannounced.

Princess Alice Hospice serves the adult population of part of Surrey and West London. The Inpatient Unit (IPU) can care for up to 28 highly complex people at any one time, it does not offer long-term in-patient care. There are four elements to the Hospice at Home service. The Hospice at Home team is usually the first point of contact for people living at home. Patients are triaged and the Rapid Response team visits people who need immediate symptom relief and support; the Night Response team provides this service after hours. The Night Nursing team provides family and carers with an overnight break and will stay by the person’s side from 10pm to 7am. When a person experienced a significant change in symptoms whilst at home, which might necessitate a hospital admission the hospice implemented the Enhanced Support service. The service had a dedicated Patient and Family Support Team and Day Services.

The hospice has a large multi-professional team consisting of medical staff, nurses, social workers, therapists and chaplaincy supported by people facing volunteers. There are approximately 800 people on the community caseload at any one time and capacity to support 24 inpatients where outstanding care and holistic support was offered to those whose illness towards the end of their life necessitates admission to the hospice.

There was a registered manager in place. 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.

Princess Alice Hospice is an outstanding service. It is focussed on the individual needs of the people and families who they support, at the time they need it in a way and place that best suits them and their whole family. The hospice ensured that everyone received good quality, personalised end of life care regardless of diagnosis, age, ethnic background, sexual orientation, gender identity, disability or social circumstances.

People and carers spoke overwhelmingly of the positive support, guidance and healthcare interventions people had received. They were full of praise for the staff in terms of their kindness, compassion and knowledge about end of life matters. People and their carers viewed the staff as experts in their knowledge and skills when supporting people with complex health needs at the end of their life. The hospice was an accredited training centre and offered end of life care training opportunities for their staff and other health and social care professionals. Through this training and other service developments the hospice had enabled people to receive end of life care closer to home and reduced the need for hospital admissions.

People and carers spoke of a service that was tailor-made for them and their families saying that staff went 'the extra mile' with empathy and compassion. Throughout their end of life care people and their families were kept involved and encouraged through creative risk taking to remain living at home at the end of their life. People’s informed consent was embodied into all work that was undertaken at the hospice and people who did not have capacity to consent to their care and treatment had their rights protected under the Mental Capacity Act (MCA) 2005.

The various departments within this hospice worked well together so that people had a seamless experience of moving from one department to another as the need arose. The end of life and bereavement support provided was tailored to meet the needs and wishes of each family member with sensitivity and compassion. The hospice was supportive of family's spirituality. They strived to offer spiritual support that went beyond faith support and staff were sensitive to individual spiritual needs and thought of ways to meet these needs when people experienced difficult times.

Staff were involved in the development of working practice, listened to, empowered with training and supported to offer excellent end of life healthcare and support. The management team promoted a culture of openness and excellence. They listened to people, carers and staff, involving them in the running and development of the service. They actively sought out their views and used feedback as an opportunity to improve and develop the service. There was a kindness and warmth about the management team that made them approachable to everyone and people knew them by their first names and told us they were visible and solved matters raised.

Governance of the service was of a high standard and robust quality assurance systems were in place that showed people were right to have confidence in this local hospice. The hospice worked innovatively in partnership with many local and national organisations to develop local services for their community and to inform and improve practice in the adult hospice sector. We saw how this partnership working had enabled young people to access appropriate adult services when they became too old for children's services and for people to receive prompt specialist support to enable them to die at the place of their choice

Inspection areas



Updated 8 November 2016

The service was outstandingly safe.

The provider had a high level of understanding of their wider safeguarding responsibility to keep the children of people who used their services safe from abuse and discrimination. The hospice had a dedicated children�s and young people�s social worker and children had been supported creatively to remain safe from harm.

There was a transparent and open culture in the hospice that encouraged creative thinking and innovative ways to manage risk and keep people safe so that they could remain living at home. Staff had an enabling attitude and had through positive and creative risk taking encouraged people to take ownership of the end of their life.

Recruitment processes for new staff were robust to ensure they were suitable to work with vulnerable people.

Medicines were administered safely. Processes were in place to ensure that people received their medicines as prescribed. Trained staff were responsible for looking after and giving people their medicines.



Updated 8 November 2016

The hospice was exceptionally effective.

The hospice contributed to the development of best practice in the hospice sector and offered accredited training opportunities to ensure staff would know how to provide people with high quality end of life care.

People's rights were respected because staff understood their responsibilities in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Where people lacked mental capacity families and other professionals were consulted when decisions needed to be made about people's care and treatment.

The hospice placed a strong emphasis on the importance of eating and drinking well. Staff and hospitality volunteers went out of their way to meet people�s food preferences and to encourage people to eat for as long as their health allowed.



Updated 8 November 2016

The hospice was exceptionally caring.

People and their families were supported by kind and compassionate staff who went the extra mile to ensure people continued to have life enhancing experiences.

People and their families were involved in planning their care which included what they would like at the end stages of life and staff found innovative and creative ways to make this a reality for people.

Support was offered to bereaved families and contact maintained if this was what the family wanted. The spiritual needs of people and their families were supported in whichever way they wanted taking into account what gave them meaning and hope.



Updated 8 November 2016

The hospice was outstandingly responsive to the needs of people and their families.

The hospice worked innovatively and in partnership with other agencies to respond to the needs of the people and families in their local community. For example the hospice had developed their Enhanced Support Service. This was to ensure when people experienced a significant change in symptoms, which may have necessitated a hospital admission, they would receive specialist support to enable them to remain at home.

The hospice ensured that everyone received good quality, personalised end of life care regardless of diagnosis, age, ethnic background, sexual orientation, gender identity, disability or social circumstances. For example the hospice had worked with two local nursing homes to improve the service provided to people at the end of life including those living with dementia.

Complaints investigations were thorough and the hospice used complaints to challenge their practice and improve the service provided for people.



Updated 8 November 2016

The hospice was outstandingly well-led.

There was excellent leadership. The registered manager had developed and sustained a positive culture encouraging staff and people to raise issues of concern and to be actively involved in improving the hospice.

The values and aims of the hospice were visible throughout the service and clearly demonstrated by the staff. The provider also had a clear strategy for developing and improving the service over time.

The service worked in partnership with other organisations to make sure they were following current best practice and providing a high-quality service. They strived for excellence through research, consultation and reflective practice. We saw evidence of the hospice sustaining their outstanding practice and improvements over time.