Northern Lincolnshire and Goole NHS Foundation Trust

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that the service met people’s needs, and thatstaff treated people equally and without discrimination.

At our last assessment, we rated this key question as requires improvement. At this assessment, the rating has changed.

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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs. Staff were committed to delivering person-centred end-of-life (EOL) care that respected people’s wishes, values, beliefs, and preferences.

The service used an electronic care record system that could be accessed by people’s GPs. Care plans included information about anticipatory medicines, administration checks and the safe use of syringe drivers. Records showed care plans were in place for all care records we reviewed and were reviewed at each visit. People newly referred to the service received an assessment of their individual needs, medical history and baseline condition to support the delivery of person-centred care. Records demonstrated consent had been obtained from all people we reviewed, and people received appropriate counselling and information about their prescribed medicines.

Care plans were developed in partnership with people, their families, and relevant healthcare professionals, and were regularly reviewed to reflect changing needs and preferences.

Care plans reflected people’s physical, mental, emotional, and social needs, including those related to protected characteristics under the Equality Act.

Our review of clinical records showed people were provided with information about their health conditions and were supported to understand their care needs. Records demonstrated people were involved in planning their care and making decisions about the support they received.

Staff respected people's preferences and worked to achieve outcomes that reflected their wishes. For example, staff worked collaboratively with healthcare professionals to arrange a prompt discharge from hospital, enabling one person to return home as this was their preferred place of care at the end of their life.

Staff are trained to communicate sensitively and compassionately, supporting people and their loved ones throughout their care.They worked collaboratively with external healthcare services to ensure there was coordinated and responsive care, enabling people to experience a comfortable, dignified, and respectful end of life in their preferred place of care wherever possible.

Feedback from people and their families was used to continually improve the quality and responsiveness of end-of-life care provided.

The service understood the diverse health and care needs of people and their local communities, so care is joined-up, flexible and supports choice and continuity.

Staff worked in partnership with other services to meet the needs of its local population and tailored their approach to meet the diverse needs of the community. For example, they had developed relationships with community groups to raise awareness of service provision through the National Dying Matters campaign.

Staff considered peoples preferences, cultural needs and communication requirements when planning and delivering care. They were able to access interpreters when needed and had information leaflets available in languages commonly spoken within the local community.

Information was shared appropriately and in a timely manner to support continuity of care, particularly during transitions between services or when care needs changed.

Care plans were regularly reviewed and updated to reflect people’s current needs, preferences, and clinical recommendations, ensuring professionals involved in care had access to accurate and relevant information.

Staff held weekly multidisciplinary team (MDT) meetings to review care, share information and identify emerging risks. Twice daily huddles were used to identify and respond promptly to immediate risks.

Systems supported access to specialist services, including tissue viability and hospice services, when required.

The service had access to the Butterfly Line, a specialist palliative care advice service delivered in partnership with the local hospice. Staff told us this service provided timely clinical advice and emotional support to people, families and healthcare professionals 7 days a week. Support included guidance on symptom management, access to specialist services and planning for future care needs. This helped staff support people to remain in their preferred place of care, where appropriate, and promoted continuity of care across services.

The service provided appropriate, accurate and up-to-date information in formats that we tailor to individual needs.

People were provided with accessible and relevant information to help them understand their care, treatment and support. Staff shared information in a way that met people's individual communication needs, enabling them to make informed choices and participate in decisions about their care. Information was available in people’s preferred spoken language when required.

Staff took time to explain information in a way people could understand and checked their understanding. They were able to provide information in alternative formats where required, including large print and visual aids. Where appropriate families supported to help people understand information about their care and treatment.

Managers had access to information relating to performance, staffing and the quality of care provided. This information was reviewed through governance meetings to support effective oversight, identify risks and drive service improvement.

These arrangements helped to ensure people could access information in a way that met their needs and supported them to be involved in decisions about their care, treatment and support.

The service made it easy for people to share feedback and ideas or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The service demonstrated a culture of learning and continuous improvement. Complaints, concerns and incidents were used as opportunities to review practice and identify learning and drive improvements. Staff were able to give examples of how learning had been embedded into day-to-day practice. For example, following concerns identified through an after-action review, pain assessment documentation was revised to better meet the needs of people with learning disabilities, supporting more effective and person-centred pain assessment.

Staff treated concerns and complaints seriously, investigated them appropriately and shared learning across the team and wider service. Complaints were managed through a centralised process in line with organisational policy, with investigations completed within timescales and senior managers providing oversight.

People and carers were provided opportunities to give feedback on the care they received in ways that met their individual needs. This included verbal feedback, written feedback and the use of technology. Feedback included compliments about care provided, as well as suggestions for improving services and activities.

People were able to share feedback or raise concerns about their care, treatment and support. Information about how to do this was accessible and staff supported people to understand the process where required.

Managers informed staff of complaint outcomes and shared learning through team meetings, one-to-one discussion and governance meetings to support service improvement. The service had adopted a ‘you said, we did’ approach, demonstrating how feedback from people using the service informed changes to practice and service delivery.

The service made sure that people could access the care, support and treatment they needed when they needed it.

The service had arrangements in place to support effective communication with people. This included access to telephone translation and interpreter services as well as communication cards to support people who were deaf or experienced communication difficulties.

Staff recognised people could face different barriers to accessing care and support and took proactive steps to identify and address these. For example, staff had supported a homeless person to access end-of-life care.

Assessments, care planning, and service delivery were tailored to meet people’s individual needs, preferences, and circumstances. Information could be provided in accessible formats where required, and reasonable adjustments were made to support people to access and engage the service.

Staff supported people appropriately when they were referred to or transferred between services, helping maintain continuity of care and access to services. Discharges were planned carefully for people with complex health and social care needs to reduce inequity in access and outcomes.

The service was able to provide a night sitting service twice a week for people with the greatest need, subject to capacity. This helped ensure additional support was available to people whose circumstances required enhanced care.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this for example, staff worked with inclusion teams to support people with complex learning disabilities to achieve their end-of-life wishes.

The provider promoted equality, diversity, and inclusion and we saw people were treated with dignity, respect, and compassion.

The service sought feedback from people using the service, their families, and healthcare professionals to identify and address any inequalities or gaps in provision. Staff treated people equally and without discrimination and proactively looked for ways to improve people’s experiences and outcomes.

Staff worked with local organisations, including the local hospice, to address local health inequalities. They understood the importance of providing an inclusive approach and made adjustments to support equitable experiences and outcomes for people using the service.

The service had effective processes in place to support access to services for people in vulnerable circumstances, including people experiencing homelessness and those from travelling communities. Assessments, care planning and service delivery were tailored to meet people’s individual needs, preferences and circumstances.

Staff demonstrated a person-centred approach by supporting individuals to achieve their wishes and maintain their quality of life. For example, staff supported a person to go on holiday, as part of their end-of-life wishes. In another instance, staff advocated for a person who wished to be admitted to the local hospice with their pet, recognising the importance of this relationship and supporting their individual needs and preferences.

Staff completed training in equality, diversity, inclusion and human rights. At the time of our assessment, compliance with this training was 100%.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. Records we reviewed showed people were supported to consider and discuss their wishes for their end-of-life care, including discussions relating to cardiopulmonary resuscitation. This information was shared with other services when appropriate. We reviewed 6 ReSPECT forms and associated documentation, which provided clear evidence of discussions with people and their families, together with the rationale for resuscitation decisions and agreed outcomes.

Staff supported people to make decisions about their care, treatment and future needs. They involved people in discussions about what was important to them and ensured care and treatment reflected their preferences and wishes.

Staff managed and communicated care for people approaching the end of their life in a sensitive and dignified manner. They considered people’s physical, mental health and social care needs when planning future care and worked collaboratively with the multidisciplinary team to support continuity of care.

Staff ensured relevant healthcare professionals and organisations contributed to planning care and treatment for people with complex needs, helping to provide coordinated and responsive care.

People told us they felt informed about their care arrangements. We observed staff taking time to explain treatment plans and expected outcomes in a way people could understand, supporting them to be involved in decisions about their care.