Archived: Marie Curie Nursing Service North East Region

Marie Curie Nursing and Domiciliary Care Service, North East Region (MCNE) is a registered provider of palliative and end of life care services to adults with terminal illnesses across the North East. The service supports people in their own homes.

At the time of our inspection there were over 200 people receiving a service.

This service is a domiciliary nursing and care agency. It provides personal and nursing care to people living in their own houses and flats in the community. It provides a service to adults. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating.

People were referred to the service by healthcare professionals. The main referral source were District Nurses. Clinical Commissioning Groups (CCGs) commission the service. Staff worked as an integrated team with other health professionals such as District Nurses and GPs. The majority of the care was provided by nurses and healthcare assistants overnight to people in their own homes.

People’s experience of using this service and what we found

People and their relatives consistently used a range of superlatives to describe the service. It was run exceptionally well. The culture, ethos and impact of the service was understood by all staff and delivered passionately and with pride in the work they did.

Staff demonstrated a commitment to the provider's values and mission in the delivery of end of life care. They were supported to show autonomy, creativity and compassion by a leadership team with an excellent range of skills and experiences.

Partnership working was key to the service’s ongoing success and its ability to influence the outcomes for people not only using the service, but across the North East in other care settings. They were seen as leaders in their field and contributed extensively to the sharing and development of best practice.

The service had clear and visible leadership. Staff had specific areas of responsibility. They regularly shared learning and maintained excellent working relationships with healthcare professionals and academics.

There were robust systems to measure the quality of the service, and opportunities were provided for those using the service and their family members to comment upon and influence the development of the service.

Staff's knowledge and understanding of people’s needs at the end of their lives was exceptional. Feedback from relatives and external professionals was consistently outstanding about how staff put people at ease and supported them.

The Rapid Response team were able to provide a unique service to local healthcare professionals who needed to refer people when their needs changed quickly.

Staff were well supported to perform this emotive and challenging role by a leadership team that genuinely cared about the wellbeing of its staff.

Concerns and complaints were meaningfully and rigorously analysed, with lessons learned and service-wide improvements rolled out where identified. The culture was one of continuous learning and creativity, with person-centred care at the heart of all developments.

Staff got to know people well in the overnight stays and formed strong bonds with people. People were treated with kindness and their individuality respected. Staff promoted people's dignity and all interactions between staff, those using the service and family members were positive to ensure the best

outcome for people.

People’s individualities, varying levels of independence and equality characteristics were respected and upheld.

Family members consistently described staff in terms that likened them to friends and family members. Staff successfully reduced people’s anxieties through their calm approach and range of training.

People's needs were met as there were sufficient staff who had the necessary skills and knowledge to meet their needs. There was a range of mandatory and additional training in place to fully equip staff to perform their roles. There were creative and inclusive approaches to training and an evident focus by the provider on supporting staff to pursue areas of professional interest.

Commissioners of the service and health care professionals who worked alongside staff were consistent in their praise of the service provided by MCNE.

Staff knew how to keep people safe, and how to report any concerns or incidents. The registered manager was proactive in learning from incidents and events, and had brought about changes to practices. There were enough staff to keep people safe. There were proactive approaches with external organisations to ensure staff could safely meet people's needs.

There were clearly defined protocols and systems for the management and administration of medicine.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff worked sensitively and collaboratively with family members to ensure people's care and treatment was in their best interests.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 27 April 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service specialises in providing nursing and personal care to people living with terminal illnesses in their own homes. At the time of our inspection services were being provided to 130 people across the North East region.

The service had a registered manager in post. 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.

We found the service was very effective in meeting its’ aim of enabling people to be cared for at home at the end of their lives. Relatives we contacted spoke highly of the standards of care and treatment provided and their confidence in the staff. They described the service as being “outstanding in every way”, “absolutely superb” and providing “brilliant support”. Feedback received by the service and commissioners reflected these positive views, with many relatives wishing they had known about and been able to use the service sooner.

A range of planned and reactive services were provided by skilled and experienced nurses and healthcare assistants. The staff were proactively supported to develop their learning in line with current best practice and the needs of the people they cared for. A variety of methods were used to ensure staff were appropriately supervised, had their performance and clinical skills reviewed, and were competent in their roles.

Nurses contributed to accredited initiatives, delivered end of life training to other providers and were looking forward to supporting student nurses during their placements at the service. Very good links and joint working arrangements had been made with the NHS and other healthcare providers, promoting co-ordinated care for people.

The service equipped staff to understand the standards required of them and checked that they put person-centred care into practice. Staff were mindful of upholding people’s rights to give their consent and direct how their care and support were given. Sufficient time was allowed for visits so that people’s care was not rushed.

Relatives were consistent in their praise of the kindness and compassionate approach of the staff. They felt care was given very sensitively and that staff treated people with great dignity and respect. A relative, whose family member had been cared for by the service, emphasised that, “The whole experience transformed my perspective of end of life care.”

Many comments were received about relatives’ appreciation of the comfort and emotional support that staff gave to families, including opportunities to rest and take breaks from their caring roles. The Marie Curie helper services were promoted to raise awareness of volunteers who could provide companionship and practical support.

Comprehensive information about the service, guidance and support on caring for people with terminal illnesses, and coping with bereavement was made available to people and their carers. People were encouraged to give their views and influence the service. Complaints were taken seriously and acted upon.

Care was taken to protect the safety and welfare of people using the service. Systems were in place to prevent risks and safeguard people from harm and abuse. There was enough staffing capacity to deliver the service and managers aimed to allocate regular staff for continuity, wherever possible. Support was provided with medicines by staff who were suitably trained.

Staff predominantly worked to care plans for people which had been devised by the district nursing service. Interim measures were taken to assess needs and risks when care documentation was not present or out of date. Good communication processes had also been implemented to provide staff with information about the care that people required.

Commissioners valued the different services provided and worked with managers to arrange care provision that was responsive to people’s needs. They expressed satisfaction with the quality, performance and management of the services they contracted.

The service was well-managed and organised, with a structure that provided staff with leadership and support. Good governance arrangements were in place with clear lines of accountability and continuous measuring of the safety and effectiveness of the service provided. There was an open, inclusive culture where people’s care experiences and standards of quality were actively monitored to further develop the service.