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