Warwick Myton Hospice

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We reviewed 7 quality statements for responsive, person-centred care, care provision, integration and continuity, providing information, listening to and involving people, equity in access, equity and experiences and outcomes, and planning for the future.

The service was inclusive and took account of patients’ individual needs and preferences.

Staff worked to make the service accessible and inclusive.

Information was provided in different ways to meet the needs of the local community.

Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.

Staff worked with the wider system to improve access to the service.

Staff worked with patients and their loved ones to plan care, including end of life care.

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.

People described care that was responsive to their personal needs because staff had time to listen to them and understand their needs and preferences. One person said, “I feel they do listen because they have more time. You have got more staff to attend to patients and they have got more time to spend. I would definitely recommend this place because it is therapeutic, I can't fault it, it is absolutely amazing and anybody in a similar situation would benefit greatly from being here”. A relative told us, “The doctors are very human; they understand what is going on." Another relative told us how important some aspects of their past were to their family member. They described how staff used that information to support their family member when they were anxious. They told us, “I did a file for [name], so people understand who [name] is and what his concerns are. What I said to the girls in here is when you have some time free, sit with him. They have sat there and at nighttime he tells them all, there is not one in here who does not know about his army career."

Conversations with people and relatives that are reflected in the rest of the report demonstrated a focus on enabling people to live their final days well, with dignity and free of pain.

The service was inclusive and took account of patients’ individual needs and preferences.

Conversations with staff evidenced their understanding of person-centred care. One staff member told us, “Because every patient is different, if you don’t adapt to them and their way, they may find it hard to respond to you. You need to follow their lead.” A member of the therapy team explained, “It is really holistic because we have more time. It is about appreciating the person and making their days valuable and helping them to be as independent as they can be. It is about making their days as good as possible and their families' days as good as possible.”

Inpatients had access to an occupational therapist and complementary therapists. The occupational therapist assisted people to use their strengths to prevent deconditioning. For people who would eventually go home or to an alternative placement, the occupational therapist assisted them in gaining strength and confidence to meet as many of their own needs as possible. For example, using the toilet unassisted, or having a wash without support.

Staff told us they asked patients about the people who were important to them to make sure that the right people were listed as their next of kin. They recognised that some people may prefer not to openly discuss aspects of their personal relationships, and they approached these conversations with tact and sensitivity They were able to demonstrate to us the types of conversation they might have to help people feel comfortable identifying important people.

Staff described a proactive approach to meeting the care needs of the local community and working with other healthcare professionals to ensure continuity of care.

Research had been undertaken to ascertain if sections of the local community were underrepresented in the patient population and what barriers to treatment they might face. The research highlighted that people from Asian communities, people affected by poverty, and older people living in rural areas were underrepresented. Staff worked with 37 organisations and joined 9 forums to try and reach people in these groups to help improve their knowledge and understanding of the hospice and the types of care offered.

Care plans were updated daily and more frequently if required to meet the changing needs of patients psychological, emotional, and physical requirements. All clinical staff could access care plans this ensured continuity of patient care.

The provider offered patient and carer well-being services to help people live as independently as possible in their own homes and communities. This service was for adults with an active progressive disease for which the prognosis was limited, and the focus of care was on quality of life. It included a nurse led face to face and telephone support service, small group work including arts and crafts, and symptom management. Other services offered included complementary therapies, which could also be accessed by inpatients, and bereavement support.

People and relatives told us staff took time to ensure information was being delivered in a way they understood.

The providers website contained an extensive range of information for patients and their loved ones, including information on dying. This was designed to prepare loved ones for the final days and hours of a person’s life so they could help comfort the person instead of reacting with panic and distress to changes in breathing. Other information included what services the hospice provided, how to prevent falls, guidance on pets visiting, information on the physiotherapy and occupational therapy teams, and talking to children about dying.

Staff understood and applied the policy on meeting the information and communication needs of patients with a disability or sensory loss. Staff, including volunteers, told us they were informed about people’s communication needs so they could interact more effectively with them.

Staff made sure patients living with mental health problems, learning disabilities and dementia, received the necessary care to meet all their needs.

We saw the hospice at home team breaking difficult news to a patient’s family. The news was given using unambiguous language and questions were welcomed. The team gave the family time to process the news and arranged to return earlier than normal to provide additional support. They made sure the family had their contact numbers in case they needed and help or support before their return.

The provider had a newly set up patient, family, and carer, support phone line. In collaboration with another charity the support phone line provided practical and clinical information and/or emotional support for people living with, or caring for someone, who has a life limiting illness or was experiencing bereavement. People could access the support phone line during times advertised on the providers website. Calls that were made to the support line outside these hours were returned during opening hours.

Staff had access to communication aids to help patients become partners in their care and treatment.

The provider’s website had a recite function so people with a sight impairment, or people who could not read English could listen to the information on the website. Text size could be altered and the screen could be magnified to make browsing the website easier for people with sight impairments.

The service had flyers in the leaflets stands with information for patients and their loved ones written in 7 languages. The flyers contained information of how to access leaflets in other languages. The hospice had a welcome message in the reception area written in 7 different languages to meet the needs of the local population.

It was easy for people to give feedback and raise concerns about care. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included people in the investigation of their complaint.

Patients told us they would feel comfortable and confident passing on any concerns or compliments to staff.

Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. For example, to increase use of the service to underrepresented groups in the local community.

They collaborated with partner organisations to help improve services for patients. This included working to improve access to specialist care. An example of this is the work undertaken to improve support to people with motor neuron disease and their loved ones.

Staff told us how patient's families were appreciative of the care they were offered and showed this through fund raising activities to support the service.

In the 12 months before we inspected 7 people had complained about the service provided across all 3 of the providers services. We saw evidence that each complaint was taken seriously, investigated, and apologies were given in line with the policy on duty of candour. People were invited to have face to face meetings to talk to with senior leaders about the complaint if that was helpful for them.

In the 12 months before we inspected the provider, across all 3 of the services, had formally apologised to people because of an incident or complaint under the duty of candour 12 times.

Patient's families and friends were encouraged to remain involved with the service for as long as they wished after their loved ones had reached the end of their life. For example, there was an annual 'Light up your life' event which was a remembrance service for people, so families had continual emotional support after the death of their loved one.

Relatives had access to bereavement counselling through the provider.

People were referred as either urgent or non-urgent. Urgent cases could be admitted the same day or within 24 hours and non-urgent cases could be admitted within 2 days of the referral. During our inspection there was a higher than normal amount of patients waiting to be admitted to the service, this reflected high levels of demand within the wider system. There were 6 patients waiting to go to Warwick Myton hospice for complex palliative end of life care and 2 waiting to go to either the Warwick or Coventry hospice. There were not enough beds available to admit all of the patients. We saw staff visibly upset, knowing some people on the waiting list needed urgent specialist palliative care and may be suffering in the community.

The hospice at home team provided personal care and symptom control for adults with a terminal illness which no longer responded to curatives treatment, and who were in the last weeks of their life. They also provided support for the whole family, including emotional and psychological support as well as practical advice. The number of patients they worked with at any one time was restricted by the size of the team and the location of patients. Two members of staff were on shift each day from 8am to 8pm, 365 days a year. The team visited patients up to 4 times a day to provide personal care. The team had 1 non-medical prescriber (NMP) who was able to prescribe and administer medicines to patients and another qualified nurse who could administer medicines prescribed by the GP or ANP. The other team members were nursing assistants. If the ANP was not on shift and a patient required a change in their medicines this would have to be discussed with the community team (GP, district nurse, and palliative care team) so a request for the patient to be reassessed could be made.

Staff told us if patients lived a significant distance from the hospice this could impact on the number of patients the hospice at home team could support at any one time. This was because of the time spent travelling from the hospice to the patient and back.

There were 8 beds in use at the time of our inspection. The beds were used for patients requiring symptom control, terminal care, or for respite patients. Although there are regional variations hospices typically receive around 20% of their funding through the NHS and rely on donations and fundraising activities for the rest of the income required to operate at capacity.

At the time of our inspection the provider had 1 respite bed open for patients with a life limiting illness. On the day a respite patient went home another respite patient arrived. Respite stays lasted 1 week and could be accessed twice a year by each patient. People could refer themselves to the service for in-patient respite care if they had received a prognosis of 18 months or less to live. Referrals could also come from relatives or healthcare professionals.

The provider recognised people could experience disadvantages because of the circumstances surrounding their ill health. They worked in partnership with another charity to provide a designated staff member who could offer advice in areas such as benefits, finances and housing.

Senior leaders told us the demand on the service reflected the wider demand within the system. On the day we inspected there were 8 patients on the waiting list, the urgency for some of these patients to be admitted was reflected by pressure in the system. We attended a meeting with system partners and witnessed the pressure partnership staff were working under to move patients out of hospital or from unsuitable placements in the community. The providers representative at that meeting worked hard to keep a focus on the clinical priority of patients.

Staff at all levels, including volunteers, expressed their concern about a lack of funding affecting the providers ability t to employ a bigger clinical team and increase the number of beds. One member of staff became visibly upset and told us they sometimes laid awake at night thinking about all the patients with complex care needs who would potentially not be receiving the care they needed.

Staff demonstrated a commitment to providing high standards of end-of-life care. One staff member told us, “Just being able to care for someone for that last day, last few hours, for me it is a privilege”.

Staff spoke openly with patients and their loved ones to try and plan the last days and hours of a person’s life met with their wishes. Staff received training to support these conversations.

The ethos of the service was to enhance the lives of people with a terminal illness to provide them with more quality time with their loved ones, and give them control over what their care should look like. The vision was to treat the end of a person’s life with the same importance that was given to the start of their life.