South Warwickshire University NHS Foundation Trust

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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality 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 inspection we rated this key question as good. At this inspection the rating has remained good. This meant patients’ outcomes were consistently good, and patient feedback confirmed this.

People were involved in the assessment of their needs. Staff assessed and evaluated patient care, taking account of physical, psychological, social and general health care needs. Care was based on evidence-based practice. There was a strong focus on meeting people’s needs at the end of life, including ensuring symptoms were well managed and people has access to the care and support they wanted and needed. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved patients and those important to them in decision making, including in people’s best interests where they did not have capacity.

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.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 9 care records during our assessment. Staff completed a comprehensive health assessment of the patient in a timely manner at their initial visit. We observed staff assessing people’s needs in person when visiting people at home and over the phone, when additional needs were identified.

Assessment processes were comprehensive. People’s needs were assessed by community teams on referral to the service. Assessment processes were holistic and included health, care, wellbeing and communication needs. Assessment findings were recorded clearly within the electronic patient record system, and records were accessible to all community teams involved in the person’s care, including their GP.

Risk assessments were carried out routinely, including risks to skin integrity, falls and nutritional needs. Pain assessments were carried out and included adapted tools to assess pain levels in people who were unable to communicate their needs.

The individual plan of care for the dying person was an integrated assessment tool used across Coventry and Warwickshire. This included an initial assessment of the needs of the dying person, their family and carers. Assessment processes included all aspects of care and the potential symptoms that people may experience at the end of life. This process supported the development of care planning, and records included an evaluation of the effectiveness of the care given.

People requiring on the day support had a triage assessment through the single point of access service where they would have an initial telephone nursing assessment by integrated care coordinators and signpost to the most appropriate community service.

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 followed up to date policies and procedures that were based on national guidance including National Institute for Health and Care Excellence (NICE) guidelines. This includes Quality Standard 13 End of Life Care for Adults and NICE guidance 31, Care of Dying Adults in the Last Days of Life. The individual plan of care for the dying person, used by the trust, was a care plan that included the individual’s wishes and priorities in line with the Five Priorities of Care of the Dying Person’. We also saw other aspects of the priorities were incorporated into the provision of end-of-life care, including the recognition of when someone is approaching the end of life and supporting people emotionally, spiritually and practically through their end-of-life care.

The trust contributed to the Care and Support Towards Life’s End (CASTLE) website. This provided up to date, integrated guidance for services across Coventry and Warwickshire. We reviewed the care records of 9 patients and found that national guidance was followed in relation to care and prescribing at the end of life. We also saw that guidance was followed in relation to the completion of Recommended Summary Plan for Emergency Care and Treatment (RESPECT) and do not attempt cardiopulmonary resuscitation (DNACPR) forms.

The trust had a suite of end of life related training opportunities including online, face to face, shadowing and simulation training opportunities for the range of multidisciplinary staff. This include the Quality End Of Life Care for All (QELCA) course. This is an internationally recognised training program, designed to enhance the quality of end of life care for patients and their families with modules on advanced communication, recognition of the dying patient and symptom management.

Staff we spoke with told us they had received an annual appraisal where learning and development needs were identified and structured plans implemented to support these. At the time of our inspection 78% of staff working within the community specialist palliative care team had received an appraisal in the last year. We were told appraisal completion had been impacted by staffing changes and unplanned absences and there were plans in place to improve the completion rate over the coming months.

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.

Staff held regular and effective multidisciplinary meetings weekly. These were attended by staff from the community specialist palliative care team (SPCT), the acute SPCT, hospices and other healthcare providers. Attendance was from a range of professionals including nurses, medical staff, occupational therapy, physiotherapy, psychology and chaplaincy. Staff shared information about patients at effective handover meetings within the team. There were daily meetings within each community SPCT locality team that looked at capacity and reviewed the team’s caseload, prioritised patient care and needs and identified any pressures within the service.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation. We observed examples of effective working together to meet the needs of patients. This included effective communication across community, acute and hospice services to meet the needs of a patient at the end of life who required an urgent admission.

There were effective relationships with services outside of the trust to ensure effective care. This included collaborative working with other NHS trusts and hospices and shared palliative care medical posts across the region.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to achieve the best quality and end of life possible.

Staff supported people to live healthier lives where possible and to ensure choice and control around what was important to them. Patients had access to physiotherapy, occupational therapy, dietician support and psychological support to support their wellbeing and independence.

People were encouraged to eat and drink what they wanted, with comfort and choice at the centre of the way staff approached supporting people. People were supported to be actively involved in planning their care and encouraged to share what was important to them.

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.

The service had implemented the Outcome Assessment and Complexity Collaborative tool (OACC) which is a validated suite of measures to identify holistic palliative care needs of patients referred to the service. The Australian Karnofsky Performance Scale (AKPS) was used by staff to score patients on a scale of 1 – 100 to identify their ability to performance daily activities. A lower score reflected increasing dependency and disability. The tool also supported the identification of the phase of illness for people at the end of life. This includes phases such as stable, unstable, deteriorating, dying with increased complexity and dying with reduced complexity. The use of the tool enabled staff to monitor patient outcomes over time. For example, data collected by the service showed that 58% of patients experiencing significant pain saw at least a 1-point reduction in their pain following intervention, with 38% experiencing a major improvement in their pain. In addition, 57% of patients experienced an improvement in relation to feeling at peace, with 32% experiencing a major improvement.

Local audits were identified and carried out by the specialist palliative care team. For example, we saw an anticipatory prescribing audit had helped to identify issues with the availability of medicines for end-of-life care in the community. Action included the development of a medicines task and finish group to address the identified issues. We reviewed an audit of the assessment of financial needs as part of the wider assessment processes. This audit led to changing the way the information was recorded to ensure that as much information as possible was sought as part of the assessment process to ensure that people received information and support when they were facing financial difficulties as a result of illness. Other audit areas included mouth care in the community leading to improved guidance and training.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. Patients understood their rights around consent to the care and treatment they were offered.

Staff sought consent from patients for their care and treatment in line with legislation and national guidance. Staff shared relevant information to support patients making informed decision about their treatment and care. This ensured patients could make decisions based on all the information available.

Staff understood the Mental Capacity Act and their responsibilities when assessing capacity to consent. Staff understood that capacity could fluctuate over time and recognised that capacity assessments were decision-specific and needed to be carried out more than once.

Training records showed that all staff had completed training in the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS).