Tynedale Hospice at Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care and support reflected these needs and any protected characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The service completed initial assessments to identify patients’ needs, risks and preferences. This included consideration of frailty, tissue viability, continence, nutrition and hydration. Patients with complex needs, including those with multiple conditions or cognitive impairment, were identified early and supported through individualised care planning. Assessments were regularly reviewed and updated to reflect changes in patients’ conditions.

There were clear processes to recognise deterioration and identify when patients were approaching the last weeks and days of life. Staff acted on this promptly, ensuring care and treatment plans were adjusted appropriately and that patients and families were informed and supported. Patients were advised how to seek help if their condition worsened, including access to out of hours support.

Staff used appropriate pain assessment tools, including for patients with communication difficulties, and care plans reflected tailored approaches to managing pain and other symptoms such as breathlessness, nausea and agitation. There was evidence that anticipatory prescribing and proactive symptom control were in place, in line with national guidance.

Nutrition and hydration needs were assessed and monitored, with involvement from dietetic services where required. Wider care needs such as skin integrity, mobility, oral care and continence were considered and informed care delivery in the home environment.

Communication needs were assessed, including sensory impairment and cognitive needs. Staff used appropriate tools and accessed interpreters or alternative formats where required to support understanding and involvement in decision making. Mental capacity assessments were undertaken where needed, with staff applying the principles of the Mental Capacity Act (2005) and checking legal documentation such as lasting power of attorney where relevant.

Carers and family members were involved in assessments and care planning, with the patient’s consent. The service recognised and considered the needs of carers, offering support and signposting where appropriate.

We plan and deliver people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The service delivered care in line with current national guidance and best practice. Staff had access to up-to-date policies and clinical guidelines, including NICE guidance for end of life care, and described how these informed their day to day practice. Policies were regularly reviewed and updated to ensure they reflected changes in legislation and evidence.

Care records and observations demonstrated that patients approaching the end of life had personalised care plans in place, including advance care planning discussions and documented preferences. Staff work closely with GPs, Community Nursing Teams, Specialist Palliative Care Teams and wider professionals to ensure timely review and implementation of end of life documentation, including Emergency Health Care Plans and DNACPR decisions.

The service had a clinical audit programme to monitor the quality and safety of care. Audit results, key themes and identified actions were reviewed every 3 months to support ongoing improvement.

Staff were supported to deliver evidence-based care through established governance systems. These included regular care services meetings, clinical and live supervision, and monitoring of mandatory training. Patient and family feedback was also reviewed and used to inform service development and improve outcomes.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service worked collaboratively with a range of health and social care partners to ensure coordinated and effective care for patients. Staff described good working relationships with GPs, community nursing teams, social care and acute services, which supported timely access to specialist advice and interventions when required.

Staff communicated regularly with other professionals involved in patients’ care, and there was evidence of shared decision making and consistent care planning. Input from a range of clinicians, including clinical nurse specialists and allied health professionals, was reflected in patient records. Staff ensured that outcomes from discussions were communicated to patients and their families to support understanding and involvement in care.

Staff were able to access specialist support and advice, including medical input and external expertise such as mental health and dementia services. Leaders supported partnership working and engagement with wider system meetings, helping to maintain alignment with best practice and service developments.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff worked with patients to identify what mattered most to them, including personal goals, preferences and priorities as they approached the end of life. This included recognising that a “good death” was an important part of care planning, with a focus on dignity, comfort and choice.

Care plans were developed and regularly reviewed with patients and, where appropriate, their families. Staff supported patients to maintain independence and make choices about their daily routines, including diet, activity and social engagement.

Patients were encouraged to remain as active as possible within their capabilities. Staff supported movement, comfort and positioning, and where appropriate, encouraged patients to get dressed and maintain normal routines to promote wellbeing.

Emotional, psychological and spiritual support was an integral part of care. Staff provided compassionate support to patients and families, including access to counselling, chaplaincy or other services where required. Patients were supported to maintain relationships with family and friends, and important life events were recognised and respected.

There were arrangements to ensure continuity of support, with coordination between services and clear communication at transitions of care.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff engaged with patients and families to identify individual goals and preferences, and used this information to define and evaluate outcomes, including achieving a preferred place of care and ensuring comfort and dignity at the end of life.

A range of quality indicators and outcome measures were used to assess service performance, including patient and family feedback and achievement of preferred place of death. These were reviewed regularly through governance processes, with oversight from senior leaders.

The service had been using an electronic health record system for approximately 1 year. Staff described the system as a positive development and valued the move away from paper records. They were open and reflective in recognising that further work was required to fully utilise its functionality.

Staff identified that the system had greater potential, particularly in relation to outcomes measurement and the consistent use of the Integrated Palliative Care Outcome Scale (IPOS). The improved use of outcome measures was recognised as an area for development to better evidence the impact of care and to support clinical decision making. A fortnightly group had been established, supported by a project manager, to help staff develop their understanding and use of the system more effectively.

The service compared and analysed performance data with other hospices through benchmarking. This was used to understand performance in relation to peers, inform service improvements and support future planning.

Staff acknowledged that interpretation of benchmarking data could be challenging, as much of the available data related to all hospice services rather than being specific to hospice at home provision. This limited direct comparison in some areas and was recognised as a constraint when analysing performance.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service ensured that consent to care and treatment was obtained in line with legislation and national guidance. Staff demonstrated understanding of the principles of informed consent and the Mental Capacity Act 2005. Patients were supported to make their own decisions wherever possible. All patient-facing staff had completed mandatory training in Mental Capacity and Best Interests.

Best interest decisions involved those important to the patient, such as family members or legal representatives, and reflected the person’s wishes, beliefs and values. Staff were aware of the need to check and verify legal documentation, including lasting power of attorney, where applicable.

Patients and families were actively involved in discussions about care, and staff sought verbal consent before delivering care on an ongoing basis. There was a culture of involving people in decisions at all levels, and staff used interpreters or alternative communication methods when required to support understanding.

Decisions relating to treatment escalation and resuscitation were clearly recorded and regularly reviewed.

A standardised consent template within the electronic health record enabled staff to assess, record and review consent at each patient interaction. This included documenting information-sharing preferences discussed at the initial assessment. The template also supported staff to record decision-making where a patient lacked capacity, ensuring essential care was delivered in line with Mental Capacity Act best interests principles.