Background to this inspection
Updated
15 January 2020
Derian House Children’s Hospice opened in 1993. The hospice provides services for children and young people with life limiting and life-threatening conditions. The hospice covers a wide geographical area including, Chorley, Preston, South Ribble, South Lakes, Fylde Coast, Wigan, Bolton, Rochdale, Blackburn, Burnley and Salford. The service provides 24 hours a day, seven days a week end of life care support. Care consists of approximately 80% respite and 20% end of life care.
The following services are provided at the hospice:
The hospice also has a comprehensive clinical education programme with a clinical skills laboratory offering practical hands on opportunities for training. It also provides families the ability to take their whole family on a short break through Derian on Holiday.
The hospice registered manager has been in post since 21 December 2016.
We last inspected the service in October 2017 and it was rated as requires improvement overall. The provider in 2017 was in breach of Regulation 11 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches had now been actioned and resolved.
Updated
15 January 2020
Derian House Children’s Hospice provides services for children and young people from across the North West of England with life limiting or life-threatening conditions. The hospice is set in its own grounds and provides accommodation in the main house and the adjacent lodge. At the time of inspection, the hospice was being refurbished to create facilities which were fit for the ever-changing needs of children and young people now and in the future. The main house was closed for respite during the refurbishment, but the lodge remained open. The service had reduced capacity to four beds to be able to continue providing respite with end of life care in a safe and efficient manner. Following refurbishment, the hospice will have 10 single patient rooms, one end of life care suite with a family lounge attached and five fully accessible en-suite family apartments.
We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on the 19 and 20 September 2019, along with an announced visit with the Derian at Home team on the 7 October 2019.
To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.
Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.
Services we rate
Our rating of this service improved. We rated it as Outstanding overall.
We found outstanding practice in relation to the hospice:
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Staff and management were fully committed to the visible person-centred approach. They all used creative ways to make sure that children and young people had accessible, tailored and inclusive methods of communication.
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Staff always treated children, young people and their families with compassion and kindness, respected their privacy and dignity, and proactively took account of their individual needs.
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The service had a strong, visible person-centred culture that was exceptional at helping staff, patients and their families express their views so that they understood things from their point of view.
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Staff were highly motivated and inspired to offer care that was kind and compassionate. Bereavement services were tailored to individual needs and were provided over a significant period after death.
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The service had a holistic approach to supporting patients, families and carers to minimise their distress. Patients were treated as individuals and staff understood patients’ personal, cultural and religious needs.
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Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment. Staff and management were fully committed to the visible person-centred approach.
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Children, young people and their families’ needs were at the heart of all services planned and delivered by the service. The service worked with others in the wider system and local organisations to plan and deliver patient-centred care.
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The service was wholly inclusive and took account of the totality of children, young people and their families individual needs and preferences. Staff made reasonable adjustments to help patients access services. They proactively coordinated care with other services and providers.
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Children and young people’s care were planned proactively in partnership with them and their families. Staff used innovative and individual ways of involving them so that they felt consulted, empowered, listened to and valued.
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Professionals from external services stated that the hospice was focused on providing a happy and fun environment. The implementation of the hospice values was achieving excellent feedback and was to be presented nationally.
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The service was flexible and responsive to children, young people and their family’s needs. The service used innovative ways to support people in the community when they were not with them. Where required, there was a rapid response to peoples changing care needs and advice on care and support was available 24 hours per day, seven days per week.
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Children, young people and their families were encouraged to give their views and raise concerns or complaints. Feedback was valued, and service users felt that the responses to the matters raised were dealt with in an open, transparent and honest way.
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Leaders were committed and passionate about patient care and provided a high-quality sustainable service. They had the skills and abilities to run the service and clearly understood and managed the priorities and issues the service faced. Leaders were visible and approachable for patients and staff. They supported staff to develop their skills and take on more senior roles.
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The service had an imaginative and child-centred vision and a clear strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.
There was a strong emphasis on continually striving to improve. Managers recognised, promoted and regularly implemented innovative systems to provide a high-quality service. Management found innovative and creative ways to enable people to be empowered and voice their opinions.
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Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff reported that the culture of the service had improved since the last inspection. The service had an open culture where patients, their families and staff could raise concerns without fear.
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Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
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Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.
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Leaders and staff actively and openly engaged with patients, staff, the public and a wide range of local organisations to plan and manage services. The views of patients and stakeholders were considered before changes were made and they collaborated with partner organisations to help improve services for patients.
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The service was focussed on service improvement and sharing best practice externally. All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. The service worked in partnership with other organisations to make sure that they were following current practice and providing a high-quality sustainable service. They strived for excellence through consultation, research and reflective practice. They also showed how they would sustain outstanding practice and improvements over time.
We also found good practice in relation to the hospice:
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The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
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Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
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Staff supported children and young people to make informed decisions about their care and treatment. They followed national guidance to gain patients consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
Anne Ford
Deputy Chief Inspector of Hospitals (North)
Hospice services for children
Updated
15 January 2020
We rated this service as outstanding overall because we rated caring, responsive and well-led as outstanding. We rated safe and effective as good.