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St Giles Hospice - Walsall Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 15 January 2020

St Giles Hospice - Walsall is operated by St Giles Hospice Group and opened in March 2011.

The hospice at Walsall offers the following services:

  • 12 inpatient beds for specialist palliative care needs.
  • A ‘Hospice at Home’ service. This is led by a registered nurse and a team of health care assistants, who provide practical and emotional care in the home for patients in approximately the last two weeks of life.

All other services such as, spiritual support, complementary therapy, allied health professionals and community palliative care services were provided by a local NHS Trust.

Furthermore, all back office, education and governance structures were supported from a sister site organisation.

In May 2017, the hospice provider launched its new five-year strategy and as part of this underwent a re-brand.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 6 - 8 March 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 service improved. We rated it as Outstanding overall.

Areas of outstanding practice

  • People’s individual needs and preferences 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 service made extensive efforts to meet patients and family’s individual needs. For example, services for children, young people and their families that allowed them to undertake activities together. There was extensive ongoing support and follow-on family support groups specifically for children and young people after they had suffered a bereavement.

  • There was a commitment to continuing development of the staff’s skills, competence and knowledge. This was recognised as being integral to ensuring high-quality care. Staff were proactively supported and encouraged to acquire new skills, use their transferable skills, and share best practice. The service also used objective structured clinical examinations (OSCE) to assess staff competence in a live manner.
  • There was compassionate, inclusive and effective leadership at all levels. Leaders demonstrated the high levels of experience, capacity and capability needed to deliver excellent and sustainable care. There was a deeply embedded system of leadership development.
  • There was an embedded and extensive team of volunteers who helped support the service. There was a volunteer strategy, a volunteer induction and training programme. Volunteers were proactively recruited, valued staff who were supported in their role in the same manner as substantive staff. The service regularly updated its policies and processes for using volunteers and innovative practice, and the use of volunteers helped to measurably improve outcomes for people.
  • Services were developed with the full participation of those who used them. The service took a leadership role in its health system to identify and proactively address challenges and meet the needs of the population.
  • Staff displayed determination and creativity to overcome obstacles to delivering care. There was strong collaboration, team-working and support across all functions and a common focus on improving the quality and sustainability of care and people’s experiences.
  • There were consistently high levels of constructive engagement with staff and people who used services. Rigorous and constructive challenge from people who used services, the public and stakeholders was welcomed and seen as a vital way of holding services to account.

We found areas of good practice:

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. Staff had access to a robust training and competency programme to ensure they had the skills required to provide good quality care.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • The service planned and provided services in a way that met the needs of local people. The services provided reflected the needs of the population served and they ensured flexibility, choice and continuity of care. The facilities and premises were appropriate for the services that were delivered.
  • Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care.
  • People who used the service were encouraged to contribute to improvements and developments to ensure the service was a reflection of the people who used it.
  • Staff felt positive and proud to work in the organisation. The culture centred on the needs and experience of people who used services. Staff told us that they felt pride in the organisation and the work they carried out to ensure patients received good quality care.

However:

  • The provider should ensure that allergies were recorded on the main treatment and prescription charts for all patients.

Heidi Smoult

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Good

Updated 15 January 2020

Our rating of safe stayed the same. We rated it as Good because:

We found the following areas of good practice:

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

  • Staff understood how to protect patients from abuse and the service worked 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 controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.

  • The service had suitable premises and equipment and looked after them well.

  • Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

  • The service had enough medical staff. Patients had access to a 24/7 medical on-call service.

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

  • The service followed best practice when prescribing, giving, recording and storing medicines. Patients received the right medicine at the right dose at the right time.

  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

However:

  • Policies were in place for the management of medical gases. A recent audit had identified some areas of risk for the management of medical gases. An action plan was in place and due to be completed by April 2019.

Effective

Good

Updated 15 January 2020

Our rating of effective stayed the same. We rated it as Good because:

  • There was a holistic approach to assessing, planning and delivering care and treatment to all people who used services. This included addressing, where relevant, nutrition, hydration and pain relief needs.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Wide ranging evidence-based techniques and tools were used to support the delivery of high-quality care. Managers checked to make sure staff followed guidance.
  • There was an embedded and extensive team of volunteers who helped support the service. There was a volunteer strategy, a volunteer induction and training programme. Volunteers were proactively recruited, valued staff who were supported in their role in the same manner as substantive staff. The service regularly updated its policies and processes for using volunteers and innovative practice, and the use of volunteers helped to measurably improve outcomes for people.
  • There was a commitment to continuing development of the staff’s skills, competence and knowledge. This was recognised as being integral to ensuring high-quality care. Staff were proactively supported and encouraged to acquire new skills, use their transferable skills, and share best practice.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
  • Staff gave patients enough food and drink to meet their needs and improve their health.
  • Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care. Innovative approaches to care were actively encouraged.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.

Caring

Outstanding

Updated 15 January 2020

Our rating of caring improved. We rated it as Outstanding because:

  • People were truly respected and valued as individuals and were empowered as partners in their care, practically and emotionally, by an exceptional and distinctive service. This included families and other people involved in patient care.
  • People valued their relationships with the staff team and felt that they often go ‘the extra mile’ for them when providing care and support.
  • Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. Relationships between people who used the service, those close to them and staff were strong, caring, respectful and supportive. These relationships were highly valued by staff and promoted by leaders.
  • Staff recognised and respect the totality of people’s needs. They always took people’s personal, cultural, social and religious needs into account and found innovative ways to meet them. People’s emotional and social needs were seen as being as important as their physical needs.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Patients and their families and carers told us that staff went over and above what they expected.
  • Staff provided emotional support to patients to minimise their distress. The service looked after staff and supported their wellbeing.
  • Staff involved patients and those close to them in decisions about their care and treatment. Staff were creative and innovative in their approach to ensure people who used the service had their requests met where possible.

Responsive

Outstanding

Updated 15 January 2020

Our rating of responsive stayed the same. We rated it as Outstanding because:

  • The service planned and provided services in a way that met the needs of local people. The services provided reflected the needs of the population served and they ensured flexibility, choice and continuity of care. The facilities and premises were appropriate and adaptable for the services that were delivered.
  • The service took account of patients’ individual needs. 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. For example, a dementia support worker role included working within care homes to improve care of people living with dementia and enabling more people to die in their home (including care homes) rather than in acute hospitals.
  • The hospice worked in partnership with the neighbouring NHS Trust. Joint initiatives aimed to divert NHS admissions and provide ‘crisis bed’ for palliative care patients.
  • The services were flexible, provided informed choice and ensured continuity of care.
  • People could access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results and shared these with all staff in the Hospice group. The service at Walsall had not received any complaints in 2018.
  • The hospice group was inclusive of all life limiting conditions and worked hard to meet the individual needs of these patients.

Well-led

Outstanding

Updated 15 January 2020

Our rating of well-led improved. We rated it as Outstanding because:

  • There was compassionate, inclusive and effective leadership at all levels. Leaders demonstrated the high levels of experience, capacity and capability needed to deliver excellent and sustainable care. There was a deeply embedded system of leadership development.

  • Leaders had a deep understanding of issues, challenges and priorities in their service, and beyond. The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care.

  • The strategy and supporting objectives and plans were stretching, challenging and innovative, while remaining achievable. Strategies and plans were fully aligned with plans in the wider health economy, and there was a demonstrated commitment to system-wide collaboration and leadership.

  • There were consistently high levels of constructive engagement with staff and people who used services. Rigorous and constructive challenge from people who used services, the public and stakeholders was welcomed and seen as a vital way of holding services to account.

  • There was strong collaboration, team-working and support across all functions and a common focus on improving the quality and sustainability of care and people’s experiences. Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

  • The service had good systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected.

  • The service systematically improved service quality and safeguarded high standards of care by creating an environment for excellent clinical care to flourish.

  • The service engaged exceptionally well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively.

  • The service was committed to improving services by learning from when things went well or wrong, promoting training, research and innovation.

  • Comprehensive and successful leadership strategies were in place to ensure and sustain delivery and to develop the desired culture.

Checks on specific services

Hospice services for adults

Outstanding

Updated 15 January 2020

St Giles Hospice - Walsall provided hospice care to adults through inpatient, day hospice and community services.  We rated the service outstanding overall because the service was outstanding in caring responsive and well led.