Little Harbour

On this page

• 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, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

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 79 (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.

Children were actively involved in the assessment of their needs, with support provided to maximise their involvement. Staff gathered and recorded each child’s preferences, likes and dislikes. Where the children could not express their preferences, the family were encouraged to advocate for them.

Communication needs were included as part of each child’s holistic assessment. Staff completed comprehensive assessments that identified communication requirements to ensure care and treatment were delivered effectively.

Staff were trained in capturing the voice of the child and recognised the importance of non‑verbal communication for many children. Individual communication needs, including preferred methods and any likes or dislikes, were documented within each child’s care plan and digital notes to support personalised and effective communication.

Following family feedback, the service introduced a system where they contacted families before arrival to ensure care plans and medicines were up to date so that staff had the most up to date information about a child’s needs before they arrived on site.

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.

Staff were up to date with best practice and national guidance. Nutritional assessments were completed for every child and young person using the service, capturing information such as food preferences, dietary requirements and any specific dietetic plans. Mealtimes took place in a shared dining space where children, young people and the staff supporting them could eat together. Dedicated catering staff were available to ensure all dietary needs were safely and appropriately met.

Staff were experienced, qualified and had the right skills and knowledge to meet the needs of patients and their families. They received regular clinical supervision, appraisals and one to one meetings. Records showed 96% of staff had an up to date appraisal. Staff participated in clinical audit processes and shared examples of quality improvement initiatives they were involved in. The service was accredited by the Crisis Prevention Institute (CPI) for managing challenging behaviour and de-escalation in care settings.

All staff had dedicated education time each year to update their knowledge and ensure their practice remained evidence‑based. Two staff members per year were supported to complete a university module in paediatric palliative care, and the organisation attended relevant conferences to remain current with best practice. Staff who attended courses or conferences were expected to share learning and feedback at subsequent team meetings to support wider team development.

We scored the service as 4. The evidence showed an exceptional standard. The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

Staff attended regular multidisciplinary meetings and shared relevant information effectively at handovers and team meetings. Staff worked closely with community teams, acute services and other hospice providers to provide coordinated care to patients and share training and policies. This included working with liaison nurses to strengthen links between acute and community services in the area.

For example, the service had worked effectively with the neonatal, neurology, medical, community nursing teams and the family to create a safe discharge plan for a baby initially referred for end‑of‑life care. The team supported a smooth transition home as was the families wish and built the confidence of community staff so they were competent to deal with the child’s needs. The child remained well in the community with ongoing support from epilepsy and neurology teams.

There were effective working relationships between the different teams within the organisation. This included the sibling support team, psychologist, medical team and family support.

The service started to prepare families for the transition to adult service from the age of 14. A transition working group was in place, and the service had helped develop a transition action plan that established a shared, cross‑organisational framework to clarify roles, expectations, information‑sharing, and ensure smooth transitions from paediatric to adult hospice care. The service was looking at introducing coffee mornings at the local adult hospice for families of young people approaching transition to enable relationship building, familiarisation with the team and informal discussion.

The service promoted shared learning by running regular professional days and collaborative palliative‑care study days for staff across the local area. These sessions explained the hospice’s services and referral pathways, explored symptom management and advanced care planning, and helped strengthen regional palliative and end‑of‑life care skills and knowledge.

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 supported patients to live their lives in as healthy a way as they could. Patients and families were offered emotional support and provided with care in a way that suited their needs.

Weekly family support referral meetings were held for any child or family identified as needing additional emotional, financial or mental‑health support. The team discussed how best to meet the identified needs, working collaboratively with families. For example, the service supported families with financial needs by helping them access grants.

The service worked closely with families to help promote and sustain their overall health and wellbeing. This included offering mindfulness sessions and other forms of emotional‑wellbeing support tailored to individual circumstances. A range of bereavement groups was available, each designed to meet the specific needs of different family members. For example, a dedicated group for bereaved fathers met a few times each year to take part in supportive walking activities together.

Staff recognised the needs of siblings and worked closely with schools to ensure ongoing support was available for them.

Nutritious, home‑cooked meals were provided during hospice stays. Alternative options were available when required, such as sugar‑free or medically appropriate meals for parents with diabetes. Dietary requirements and allergens were consistently documented to minimise risk and ensure safe meal provision.

The service was able to support families that needed food bank vouchers. Also families were able to get into local attractions for free. Staff responded to changing needs as they occurred and communicated this to partner agencies.

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 used recognised tools to identify and respond to clinical deterioration in patients as a key element of patient safety and improving patient outcomes.

There were effective approaches to monitor people’s care and treatment and their outcomes. Most of the outcome data collected related to patient and family experience and was qualitative. This feedback was gathered through experience surveys completed either by families or by the patients themselves, providing insight into how well the service met their needs.

Outcome information which had been collected by the service contained data around the activity of the service including numbers of stays and referrals. Results demonstrated staff were achieving positive outcomes for their patients.

The service strived to make continuous improvements to the experience and the care and treatment people received. Staff completed local audits including infection prevention and control, pain and medicines audits to drive improvement.

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.

Staff took all practical steps to enable children and their families to make their own decisions. Records we reviewed had clear documentation within them where consent had been sought prior to proceeding with care and treatment.

Staff appropriately assessed and documented mental capacity for children and young people who may have had reduced ability to make decisions about their care. When patients lacked capacity, staff made decisions in their best interests, included the family and recognised the importance of the person’s wishes, feelings, culture and history.

The service used appropriate documentation to record the wishes of the child or young person. They used advance care plans (ACPs) and recommended summary plan for emergency care and treatment (ReSPECT) forms to record the decisions, preferences and agreed care approaches for each child or young person, or the advocate or person responsible for them.