East Lancashire Hospice

On this page

• 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

Staff we spoke with said there was good multidisciplinary team (MDT) working both internally and with external stakeholders. There were internal meetings with groups of staff and meetings that involved health professionals outside of the organisation. There was a seven-day service for the inpatient unit, hospice at home and single point of access with the outpatient services and clinical nurse specialists available five days a week. Staff completed training in consent and safeguarding of patients to understand the processes. An external pharmacy supported with medicines management which included the review and audit of prescriptions to address symptom management for patients on the inpatient unit. Learning from incidents had been shared and included no harm and low harm. There was a referral process for patients to access care from all parts of the local area including from the neighbouring NHS hospital and community such as GP’s and district nurses. Patients were assessed for their suitability for a service. Records of patient care were maintained using a combination of electronic and a limited amount of paper-based patient records. These included specific patient care needs including for example preferred place of care and death. There was a staffing tool to calculate establishments/requirements, including regular reviews, for all areas within the organisation including inpatient, outpatient and clinical nurse specialists. Recruitment processes were ongoing to fill any vacancies. Regular bank staff supported any adhoc absences. Staff files that we reviewed during the onsite inspection generally included the required documentation, however some gaps were noted. Staff completed a programme of mandatory training and ongoing refreshers to maintain competencies. They completed annual appraisals and had a programme of supervision for support. At the time of inspection, there was a strong emphasis on well-being of staff with activities planned throughout the year.

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.

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

Patients and those close to them said they felt listened to and were involved in care and treatment planning. Patients and carers reported becoming involved in the service from initial outpatient services such as counselling and complementary therapies so they were confident to choose the hospice as their preferred place of care and / or death (PPD). The provider requested feedback from those receiving care and treatment. Patients and those close to them were positive about the care they received. Comments included caring, friendly, understanding, compassionate, supportive, respectful, calm, helpful, kind, comforting and professional. In the care of the dying audit completed in November 2023, it showed that discussions were held with patients regarding do not attempt cardio pulmonary resuscitation (DNACPR), however it was not always documented if and when this was discussed with those close to the patient. Patients said they received effective pain relief in a timely manner and relatives agreed with this.

All staff reported good multidisciplinary team (MDT) working including with the local NHS trust. MDT meetings were held weekly and involved internal health professionals from the hospice and external organisations and stakeholders. The meetings discussed complex patients, new referrals, discharges and transfers. Doctors and other staff attended the inpatient handovers which included any requests for the medical director to review individual patients. The medical director worked closely with the consultants and reported positive working relationships. A clinical heads forum was planned monthly where agenda items discussed included risk reporting, occupational health arrangements, referrals, electronic prescribing, annual leave, activity, appraisals and departmental updates. There were inpatient staff and senior staff meetings held monthly that focused on day to day operations such as updates in staffing, processes, equipment or training requirements. Staff were encouraged to attend and were given time to attend. The supportive care team had team meetings where any updates were shared. However the last meeting was in November 2023. Most staff felt listened to and supported. Senior leaders provided opportunities for staff to express any concerns including one to ones, freedom to speak up, team meetings and well-being sessions. Staff commented that the hospice feedback on care was not accessible or inclusive as the questionnaire was too long and was accessed by the website or via a QR codes on the inpatient rooms. All incidents were reviewed by the registered manager. Staff received feedback following incidents and debriefs held where there was significant learning. This was known as ‘Closing the loop.’ Staff also reported a one to one buddy system for support and learning. Following two serious incidents last year there was evidence of learning and implementing actions against an action plan. There was evidence improvements had been made as a result of the learning.

Patient referrals came from services including the NHS hospital GPs and district nurses. All patients were assessed in the community and they were supported to manage at home. If they needed more support for example, to manage pain relief and medicines they were offered an inpatient bed. The medical team prioritised referrals for inpatient care for people with complex needs and those who were in their last few days of life, where this was their preferred place of death, or their needs were too complex to be managed effectively at home. The provider had approximately 100 patients under hospice at home care which also included all fast-track referrals. Data provided showed an average of 66% inpatient bed occupancy for the first three months of the year and a consistent under occupancy in the previous 12 months. The admission rate for the same period was higher than the previous three months but on average it remained around 39.5%. Average waiting times from referral to the first contact with the clinical nurse specialist team, was 6.7 days in October to December 2023 compared to 2.5 days in quarter four 2022/23. Patient records were completed and updated appropriately with evidence of discussions with patients, carers and internal and external partners. The provider had transferred most of their clinical paper records to electronic and was in the process of transferring to electronic prescribing. Records were stored securely on site. We observed in care records that staff carried out holistic assessments, such as, preferred place of care, preferred place of death, their religion if any, and do not attempt cardiopulmonary resuscitation (DNACPR) paperwork. Risk assessments were completed such as falls, manual handling, pain scores, pressure ulcers and application of the integrated palliative care outcome scale (IPOS). The IPOS is a group of tools to measure patients' physical symptoms, psychological, emotional and spiritual, and information and support needs.

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.

Leaders said they assessed staffing on acuity and had over recruited at times to support patients on the inpatient unit which had been impacted on by previous staff sickness. Staff said there was currently safe staffing on the inpatient unit. Staff gave examples when they had experienced significant pressures and the impact on staff well-being when there had been patients with very high acuity needs over an extended stay. Doctors reported they were fully staffed and had recently recruited two new posts. All rotas were covered with on call provision out of hours. Doctors reported there had been significant pressure when dealing with long term high acuity and medical sickness which had impacted on well-being. Doctors said work load was now manageable. All staff said they had been supported with revalidation (where applicable) and received appraisals. Doctors and consultants working under practicing privileges had appraisals with their own organisations. Leaders said supervision was being made mandatory with a significant amount of investment to enable staff time to undertake it. The provider had linked in with Hospice UK to provide resilience supervision training. Some staff said they had already completed a palliative care training course, prior to employment, so had not undertaken it at the hospice. Some staff had requested undertaking further palliative care training which had to be financially approved. Some staff felt they did not always receive enough training and development opportunities or that the provider made best use of their skills and abilities. The provider had invested in staff development opportunities for the upcoming year. Leaders described how they managed performance of staff and conflict within teams. Staff and managers had access to one to one supervision and used it to manage challenges where required. The registered manager also spoke to teams and individual staff to try and resolve any conflicts.

Recruitment processes were reviewed by checking records. We found they were generally complete except the reasons for gaps in employment were not documented in three out of the five records. The provider used a staffing tool to ensure safe staffing numbers. The staffing level establishment for the 10 bedded inpatient unit was a shift co-ordinator, two registered nurses (RNs) and two health care assistants (HCAs) during the day shift and two RNs and one HCA during the night shift including a shift coordinator. The service had bank staff who worked at the hospice. The hospice at home service was staffed by HCA's and a registered nurse. There were clinical nurse specialists (CNS) that had some long term absence. This meant the service had reduced to five days rather than seven. The average waiting time from referral to first contact with the CNS team was 6.7 days in October to December 2023 compared to 2.5 days in quarter four 2022/23. Staff sickness had increased from 2.7% in January to March 2023 to 7.3% October to December 2023. A slight decrease from 7.8% to 7.3% was noted in data in the last six months. The service had five hospice physicians. This provided the medical staffing establishment as 2.41 whole time equivalent (WTE). Four consultants employed by the local trust provided 0.4 WTE consultant hours. Consultants carried out ward rounds twice weekly and contributed to the on- call rota. All new staff completed an induction and training for their role. The service had a training schedule that for clinical substantive staff included a range of modules that included learning disability and autism. Overall compliance was 96.34%. All clinical staff undertook adult and children and young people safeguarding training to level 3. The safeguarding lead was trained to level 5 and two staff were level 4. For bank nurses, there were training requirements that did not include all modules undertaken by other staff. Compliance with annual appraisals was 93% for staff.

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.