St Helena Hospice

St. Helena Hospice is a charity which provides a range of hospice services for anyone over the age of 16 with a life-limiting illness living in North East Essex and the Colne Valley area of mid Essex. St Helena Hospice provides a range of palliative care services to patients at home, through two day centres [Joan Tomkins in Colchester] and in an inpatient unit that has 15 beds. In addition the hospice offered a 24 hour telephone advice line, a range of complementary therapies, counselling, support for carers and bereavement support groups that was also available to children.

There was a registered manager in place at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service had a strong person centred approach. People's dignity was supported and staff treated people with respect at all times. Staff were exceptional at helping people to express their views. People and their families who received care, treatment and support from St Helena could not speak highly enough about the staff who supported them. People who were challenged in coming to terms with a life limiting illness or a terminal diagnosis told us repeatedly that they were enabled to manage their condition and their emotional wellbeing because of the excellent care and support received from various departments within St Helena hospice. Staff were exceptionally kind, caring and compassionate. People we spoke with were only too pleased to share their stories of compassionate appropriate care, treatment and support.

The hospice was proactive in reaching out to communities who did not traditionally access their services. Innovative methods had been used to encourage people to access the support available to them. The model of care delivered was one of inclusion and acceptance and promotion of diversity. The ‘Safe Harbour’ project provided hospice services and supported people on the fringes of society, such as those affected by homelessness, alcohol and drugs misuse.

People received excellent care based on best practice from experienced staff with the knowledge, skills and competencies to support their complex health needs. Staff were supported and coached to deliver care and support following best practice guidance. People and families received care from staff and volunteers who developed positive, caring and compassionate relationships with them. Staff worked together as a multidisciplinary team and had excellent links to community based services to provide the care people needed.

Staff had permanent support and guidance from social care professionals employed by the hospice and were trained in how to protect people from abuse and harm. Staff were proactive and knew how to recognise signs of potential abuse and how to put measures in place to overcome safeguarding issues. Risks to people`s well-being were assessed by staff daily and there were measures in place to mitigate risks and keep people safe as they could be. Risk assessments were reflective of people`s changing abilities and needs and measures to ensure people were as safe as possible were implemented accordingly.

People told us they were fully involved in setting their priorities for care. Care plans in regard to all aspects of people`s medical, emotional and spiritual needs were personalised and written in partnership with people. Staff delivered support to people respecting their wishes and preferences.

People who used the various services offered at the day hospice told us the help and support they received was invaluable for them and their family. They valued the support they received from the different activities, courses and clinics which helped them to live with and manage their symptoms to maximise their health and helped them prepare for the future.

People`s consent to their care and treatment was regularly sought. People’s aspirations, preferences and wishes were known by staff. People were asked what was important to them and supported on their journey to make decisions and choices about advanced care plans and desired places of death.

The SinglePoint service was a national award winning telephone advice line which offered support, assessment and advice to people with life limiting condition living in their own homes over 24 hour seven days a week. The support could be accessed via telephone where the calls were triaged and staff could arrange support for people if it was needed. People told us they received the care and support they needed when they wanted it –even in the middle of the night in their own home. People felt very assured by the range of support options.

There were sufficient staff employed in each department to ensure people’s needs were not only met in a timely way, but so that staff could spend meaningful time with people when needed. People appreciated that staff had time for them when needed. Staff were safely recruited. The staff group are well trained and supported. Staff were consulted through surveys and listened to by management. People had opportunities to be involved with the running of the hospice. Volunteers were valued and involved. The management style was inclusive and open.

The registered manager and staff had a strong set of values that placed people at the heart of the service. All staff constantly strived to work towards these values throughout the organisation. There was a culture of openness and taking responsibility with complaints used to drive improvement and quality assurance systems looking at ways to develop practices and make matters better for the benefit of people using the service.

During our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People all told us that they felt safe when they visited the Day Centre or IPU. One person in the IPU said: 'I feel so safe here. I had all those fears and they've helped to allay them all.' Another person told us: 'You are safe here. I was so frightened at home when I needed help.'

People told us that they felt their rights and dignity were respected and they felt in control of decisions about their care and support. There were good systems in place to protect people from poor practices or potential abuse.

Is the service effective?

People told us that the hospice service was extremely effective in meeting their needs. One person said: 'My pain was so bad before I came to the Day Centre that I couldn't get any sleep. I thought I'd just have to live with the pain. I came here, they prescribed a different pain killer and I'm now pain free.' Another person in the IPU told us: 'They've helped all my symptoms. I didn't think care this good was available.' A third person described their recent stay in the IPU as 'immensely beneficial'.

Is the service caring?

People were extremely complementary about all the staff. One person told us: 'It doesn't matter what they are asked to do they all go out of their way to help.' Another person said: 'Everyone including the volunteers and cleaners are all so caring. They all have time for me. Any concerns they can take away from me they do. They've given me my dignity back.'

Is the service responsive?

All the people we spoke with told us that the staff were very responsive to their needs and wishes. One person said: 'Everything is a joint decision. They explained the different pain killers and asked me what I wanted.' Another person told us: 'They listen to me here and that means a lot to me. They didn't listen to me at the hospital.' A third person said: 'I just ring the bell and they're here.'

The hospice had introduced a service called 'SinglePoint'. This provided a single telephone number and point of access to palliative care services. A team of registered nurses provided support and advice at any time of the day and night. They assessed the urgency of the support and care required and arranged for the most appropriate member of staff to respond. People we spoke with were very appreciative of the service and said that it gave them a 'lifeline' when they were at home.

Is the service well-led?

One person who had attended both the IPU and day services told us: 'The service is exceptionally well led. I cannot speak highly enough about all the hospice staff. ' Another person told us: 'Everything is well organised. The teamwork is very good.'

The senior management team was leading collaborative work with local hospitals, ambulance services and commissioning groups. This was helping to provide a much more integrated and coordinated service for people with palliative care needs. It also helped to reduce avoidable admissions to hospital for people receiving end of life care.

During our inspection we spoke with three people attending the day unit, three people in the inpatient unit and one relative. All the people we spoke with were extremely complimentary about the services they received. They felt fully involved in all decision making. They told us that staff and volunteers, without exception, provided an excellent service. One person said: 'I'm treated with dignity. I'm not just a patient, I'm a person.' The relative we spoke with said: 'They look after X very well and look after me as well.'

The hospice had a commitment to continuous quality improvement of the services, treatment and care that they provided. They provided training that enabled staff to meet people's individual needs. There was evidence of actions taken to address the issues raised by people and their carers and evidence of improved standards within the services following audits.