Archived: St Christopher's Bromley

Updated 9 December 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 15 and 22 September 2016 and was announced. We gave the provider 48 hours’ notice of the inspection because we needed to be sure senior managers and staff would be available to speak with us on each day of our inspection. The inspection team consisted of two inspectors and an expert by experience. Our expert by experience was a person who had personal experience of caring for someone who had received end of life care.

Prior to the inspection we reviewed the information we held about St Christopher’s Bromley, including the statutory notifications we had received. Statutory notifications are what the provider has to send to the CQC about significant events concerning the hospice. We also reviewed the information included in the provider information return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the hospices most recent annual quality accounts report which services’ commissioned by the NHS are required to complete which gives information about the quality of the service they provide.

During our inspection we spoke with six people who were attending the Caritas centre and three family members/carers. We also met 20 managers/heads of departments, 25 other members of staff and six volunteers. Clinical staff we talked with included the services registered manager and director of nursing, two consultants, two nurse managers, six community nurse specialists (CNS), the allied health care professionals lead and an occupational therapist.

Non-clinical managers and staff we spoke with included both St Christopher’s Joint Chief Executives (JCEs), the new head of quality assurance and governance, the manager of the Caritas (Orpington) and Anniversary (Sydenham) day centres, the head of patient and family support, four social workers, a bereavement councillor, the spiritual care lead, the volunteers coordinator and two facilities and estates managers.

We undertook general observations during our time spent at the Caritas centre. We also attended a 'gentle’ exercise class facilitated by an occupational therapist. We looked at the file for fourteen members of staff and five volunteers. We were supplied with additional information relating to the overall management and governance of the hospice on request. This included accident and incident reports, complaints, compliments, health and safety checks and quality monitoring audits.

Over the course of this two day inspection we made telephone contact with a further 40 people living in South East London who had received a community and/or day centre service from St Christopher’s and 25 family members or informal carers. We had additional feedback from five Clinical Commissioning Groups (CCGs) in South East London (Bromley, Lewisham, Lambeth, Croydon and Southwark CCGs) who formed a consortium to agree a range of end of life services, under one overarching contract. We also received comments from four social care professionals who managed nursing and care homes in Bromley and Croydon for adults with learning disabilities and for older people living with dementia and looked at an audit of the hospice undertaken by Bromley Healthwatch. Healthwatch is the national consumer champion for health and care in England. Finally, we looked at the outcome of various service user and staff satisfaction surveys conducted by the provider.

Updated 9 December 2016

This inspection took place on 15 and 22 September 2016 and was announced. The service was last inspected on 25 November 2013 and at that time was meeting all the regulations we looked at.

St Christopher’s Bromley (Orpington) has charitable status and provides palliative and end of life care to a population of approximately 1.5 million people living in the five South East London Boroughs of Bromley, Croydon, Lewisham, Southwark and Lambeth. The hospice will accept initial referrals from anyone in the community who knows an adult with a life threatening or life limiting condition. Care, treatment and support is provided to people with a life threatening/life limiting illness, their families, carers and friends by a range of multi-disciplinary health and social care professionals including doctors, nurses, health care assistants, physiotherapists, occupational therapists, dieticians, social workers, chaplaincy, welfare officers, art and complementary therapists and volunteers. The hospice also offers information, advice, education/training and research opportunities to individuals, groups and institutions wanting to know more about end of life matters and the work undertaken by St Christopher’s at a local, national and international level.

Although the hospice has two different sites located at Orpington and Sydenham in Bromley, St Christopher’s considers itself to be a single provider with people in the local community, their families/carers, staff and volunteers visiting or working at both sites. This report relates specifically to the Orpington site which comprises of the Caritas day centre, café and garden, numerous clinical and meeting rooms for patients and their families, a large teaching room that forms part of the St Christopher’s education facilities and a dedicated Lymphoedema suite. The Lymphoedema service serves the whole of Bromley and operates both from Caritas House and also offers a home visiting service.

The Caritas centre offers people in the local community, their families and informal carers' physiotherapy, psychological support, social work services, bereavement counselling and spiritual care in an environment where they can relax, socialise, support each other and make use of a range of therapies to explore their experiences. Nurses agree a care plan with each outpatient and can refer individuals to other services such as group work programmes, exercise classes, the pop-up rehabilitation gym or clinic appointments with other members of the multi-professional team. People are offered an initial programme of 12 sessions after which their care plan is reviewed. The centre also provides people with information and trained volunteers are on hand to help people find the information they need. The hospice has increased the levels and range of supportive care services that run from the Caritas centre in 2015/16.

The specialist community palliative care team and outpatient team operates in collaboration with local primary health care teams to provide people, their families and/or carers with end of life care and support. Its primary task is to manage symptoms associated with people’s illnesses and to support them and their families through the illness and into bereavement. The team also provides a 24 hour consultancy service and training for primary health care teams, social and healthcare staff in other settings such as care homes, and domiciliary care agencies.

The hospice clinical nurse specialists work a shift system up until 10pm. Overnight, the advice and visiting service is managed by senior nurses on duty in the inpatient wards at the Sydenham site. Staffing levels for this reflect the need for community support. Medical advice, support and patient assessment is also available from the medical team 24 hours a day/seven days a week. In addition, the hospice has a hospice at home service providing practical nursing care to support patients and families at home in the last days of life. St Christopher’s creative arts and complementary therapy team also work with staff in care homes and related projects in the local community.

St Christopher's pastoral and counselling/bereavement services are available for children, adults and their families. The hospice has three distinct bereavement services for adults following the death of someone under the care of the hospice, for anyone who is bereaved and lives in Bromley and the Candle project for children and their families.

At the time of our inspection the community palliative care team support around 500 people in the community at any one time and offer advice and a specialist 24 consultancy hotline for over 100 care homes in South East London. Over 300 people regularly access the Caritas centre use their facilities and over 1000 people including children, adults and families have received formal bereavement support from the hospice in 2015/16.

The service had a registered manager in post who is also the director of nursing. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Management, staff and volunteers were highly motivated and committed to ensuring people and their families/carers received the best possible end of life care and support in accordance with people’s needs, choices and preferences. There were effective arrangements in place to offer practical and emotional support to people and their families to help them cope with dying and death.

People and their families told us staff and volunteers looked after them in a very kind, respectful and compassionate way. Feedback we received from people, their families and community professionals supported this. We saw staff and volunteers built good working and caring relationships with people and their families and always treated people as individuals’ and with the utmost respect and dignity.

Staff and volunteers were clear about their roles and responsibilities. People received care and support from a multi-disciplinary team of highly qualified health and social care professionals who were well trained and supported by their co-workers, senior staff and managers. There was a very proactive approach to the personal development of staff and the acquiring of new skills and qualifications. A system of competency based assessments ensured staff could demonstrate they had the required knowledge and skills to effectively meet people’s needs and wishes. Systems were also in place to support staff and volunteers to enable them to reflect on their own practice and that of their co-workers. This provided staff and volunteers with the knowledge, skills and confidence they required to meet people’s need and wishes in an outstanding and personalised manner.

The hospice demonstrated a strong commitment to providing people with good outcomes and high quality care, and to continually improve, extend and develop the service to reach as many people as possible. The hospice had developed a number of innovative approaches to reaching more ‘harder to reach’ groups in the local community. This included individuals who did not previously receive any specialist palliative care services because they did not have a primary diagnosis of cancer. The hospice had responded to this challenge by setting up the Bromley Care Coordination (BCC) team.

The service is committed to working collaboratively with partners to deliver and inspire better care for those affected by life limiting illness. Staff worked in partnership with a wide range of external health and social care professionals and other organisations to improve the services St Christopher’s offered people in the local community. Staff were encouraged and supported to undertake research and act as education facilitators to share best practice and ensure high quality outcomes for people with life-limiting conditions and those closest to them.

People received a personalised service. People were supported to make informed choices about their end of life care and to have as much control as possible about what happened to them before and after their death. Person centred care plans reflected people’s specific needs and preferences in respect of how they wanted to be cared for, treated and supported. Staff ensured people received all the necessary information in a way and at a pace they could understand. This enabled people and their families to make more informed decisions about the end of life care, treatment and support they wanted. Consent to care was sought by staff prior to any support being provided.

Robust systems were in place to enable people to receive support and advice whenever they need it. This included a 24 hour advice and visiting service for both professionals and patients. People can be admitted to the community palliative care service at any time.

People and their families/carers were able to access a wide range of group and individual social activities and educational classes held at the Caritas centre. People also told us staff understood their emotional needs and focused on their wellbeing as well as the wellbeing of their family member. There was a family support team which provided pre and post bereavement counselling for children, adults, their families and friends.

People’s cultural and spiritual needs were respected and care and support was provided in line with an individual’s faith and customs. Staff had received training and were aware of different religious and cultural practices at the time of and after death. There was also a chaplaincy service to support people and their families with their spiritual needs.

There was strong emphasis on the importance of good nutrition and hydration and a commitment to providing people with what th