St Richard's Hospice

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The safe key question remains rated as good. Three quality statements, safe systems, pathways and transitions, learning culture and safe and effective staffing, were included in this assessment. The service demonstrated safe and effective systems and staffing.

This service scored 81 (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 managed incidents well and demonstrated a learning culture. People that we spoke with during the inspection knew how to raise a concern if they needed to. Information leaflets and posters were clearly visible throughout the service. Patients that we spoke to did not have any complaints about the service. The service had received 2 formal complaints within the 12 months prior to our assessment. Both were investigated thoroughly, and the service worked with the families to ensure that the complaints were resolved to their satisfaction. The service demonstrated learning from both the complaints. One of these, about pressure ulcers, contributed to the service instigating a deep dive into pressure ulcer care. Nursing teams were supported to learn from this, with an additional learning session being created for nurses. The service used an electronic incident reporting system to record incidents and complaints. The service was using a newly introduced method implemented in the NHS to record and learn from any patient safety incidents in a blame free and supportive way.

Safety was a top priority in the service which had a culture of safety and learning. This was based on openness, transparency and learning from events that had put patients at risk of, or that have caused them harm. A deep dive review of falls had been undertaken by the service which included reviewing the age, number of individual patients that had fallen versus the number of falls as well as reasons for them. recommendations were produced discussed at clinical quality committee and shared with all staff along with the falls procedure and updated falls risk assessment. The service demonstrated how ensured duty of candour was undertaken. Clinical incident trend analyses had been carried out. Safeguarding concerns followed by pressure ulcers were the greatest number. The review highlighted that the majority of pressure ulcers were acquired before admission however learning from the review had resulted in changes in the documentation of pressure ulcers within the service to better identify this. The service worked to continually improve care, treatment and safety for patients and their loved ones. A mouthcare matters project was in place, A palliative knowledge network programme, family support screening tool, my wishes document, what matters to me assessment and safeguarding advocate roles had all been created. Whilst low fibre diets for patients with malignance bowel obstructions and eye movement desensitisation and reprocessing therapy for relatives supported their care and treatment. During a period of building work, the service had a virtual ward whereby people could receive the same care and treatment in other settings such as at home. This was used as an opportunity to pilot a virtual ward. Information collected from this pilot was being used to develop and redesign community nursing services.

Staff supported patients to be involved in their own care. This enabled patients to maintain as much control as possible throughout their care and treatment. Staff worked with patients when moving between services, such as from an acute hospital, to community care to the hospice; and ensured patients had all relevant information. We saw that risk assessments were person-centred and were focused upon patient wishes. People told us that they had felt involved in their own care and the care of their loved ones and were informed of transitions to different services. We also saw how the service collaborated across the healthcare network to provide timely access to medication, equipment and support to the patient and their loved ones. Leaders explained how they worked with the Herefordshire and Worcestershire palliative and end of life network to review and audit their care against the ambitions for end of life care national framework.

Staff told us they could access the information they needed. At the time of the inspection, the service was upgrading their electronic patient record to better capture patient outcomes. Some paper based care records were transitioning to the electronic patient record such as records of mouthcare, pressure ulcer care plans and pain assessment charts. This supported the wider organisation to have oversight of these. Staff could also access other professional services when needed such as speech and language therapists, mental health professionals as well as psychologists. They told us there were risk assessments undertaken for COVID-19, whether staff should be wearing a mask, wheelchairs and falls. The service worked closely with other services to support patient pathways and transitions. A regular integrated care model workshop took place. The service were working with the system to put in place the proposal for the end of life hub. This had been created to work in collaboration with other services including local university, elderly care charities, local ambulance, general practitioners and acute trusts. A 24 hour on-call service, a sitting service pilot and an end of life hub pilot scheme were all part of the model. The service undertook a review of urgent community response telephone calls across the area. This demonstrated that out of 1033 telephone calls, 590 related to end of life care and pain/symptom control. This had led to work with care homes and ambulance providers to help educate and support staff and patient families. A virtual ward had been set up to support patients in their care at home.

The service worked closely with system colleagues including general practitioners to support safe systems of care for patient both within the unit and in the community. Managers held meetings with NHS acute healthcare providers to ensure safe and effective transfers of care. The service asked for feedback from these providers to ask what was working well and what could be improved. Following this feedback, changes were made at the service to improve patient transitions from one service to another. The service hosted networking meetings to strengthen partnership working.

The service had a strong awareness of the risks to people across their care journey. Minutes from the November 2023 integrated model workshop showed that issues such as family anxiety and not knowing where to get support from in time of crisis had been discussed. Key policies such as opioid respiratory depression guidelines and tracheostomy care for patients both in the hospice and community were reviewed at clinical quality meetings and a pathway for psychiatric review had been created. Continuity of care was a clear priority for the service, this was reflected across all services provided. Living well team offered individualised care and support to patients and their loved ones. We saw an example of a patient with dementia and their loved one receiving personalised massage therapies at the time of the inspection. A hospice at home service and community nursing service supported patients to remain in their place of choice throughout their care journey. Whilst a dedicated family support team worked closely with loved ones throughout their own journey. During the inspection we saw how the service worked collaboratively with others such as general practitioners, pharmacists and district nurses to ensure appropriate and timely care was received. We also saw how allied health services such as occupational therapy, physiotherapy and social workers were a key priority of patients care. The service worked in collaboration with a health and care trust to provide a 24 hour 7 day a week palliative care consultant on call list.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Patients and relatives experience of staffing within the service was positive. This included the staffing of volunteers who supported throughout the service including in the community. Patients and relatives told us there had been enough staff taking care of them and that they felt staff communicated with them well. Relatives told us that staff had made them feel important and included in their loved ones care. All 121 respondents to a patient and family feedback survey rated staffing throughout the service as excellent and good.

There were sufficient staff to provide patient's with high quality and safe care and treatment. Staff received training and ongoing development opportunities. Staff told us they had received an annual appraisal as well as clinical supervision in line with the policy in place within the service. Information provided by the service demonstrated that all staff had an in date appraisal. Staff told us how there were lots of opportunities to develop their knowledge and skills, with clear development pathways set out for both community and inpatient members of staff. Accredited learning such as non-medical prescribing and masters levels modules were available to staff. Mental health first aider and patient champion roles were in place and enhanced communication modules based on role were being created. At the time of the inspection a large piece of work had been undertaken to split statutory, mandatory and role enhancing training for all staff so that there was a clear development pathway in place. Staff told us that training workshops were offered weekly and advertised in the weekly bulletin, they were open to all staff and included sessions such as deaf awareness, learning about homelessness and race awareness training were provided by the service.

The service made sure there were enough qualified, skilled and experienced people to deliver effective, safe care and treatment to meet people's needs. Policies and procedures such as recruitment and selection, training and supporting volunteers were in place and coordinated by a central human resource team who also carried out repeat disclosure barring service checks and professional registration checks. Local induction arrangements for bank and agency staff working within the service were carried out. Rota checks were completed by senior leaders to ensure suitable cover was in place and managers could flex the rotas depending on patient needs. Medical teams were on site between 8.30am to 6pm 5 Monday to Friday and for 6 hours Saturday and Sunday. On call medical cover was available outside of these times. During the inspection we saw that at least 6 mandatory clinical supervision sessions were held annually with each member of staff. These sessions included group supervision, 1:1 supervision peer supervision and managerial supervision. A volunteer co-ordinator supported volunteers through an induction process and with ongoing monitoring and formal supervision and bespoke volunteer meetings.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.