St Helena 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

We did not look at this key question during this assessment. The score below is based on the previous rating for this key question.

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.

Patient’s we spoke with during our assessment felt safe, well cared for and knew who to contact should they need to. They told us they were involved in the planning of their care and were kept informed of what would happen next. For example, we saw staff had discussed a patient’s wishes on care and treatment prior to admission, and kept them informed in relation to being discharged home. Patient comments included, "Staff are very approachable", and "Staff are phenomenal, they are people of peace".

There were effective systems and processes in place, and a strong awareness of the risks to people across their care journeys. Staff knew about and dealt with any specific risk issues. Staff completed and updated risk assessments for each patient and removed or minimised risks. We saw that staff monitored patient risks, including but not limited to, falls and pressure ulcers. Risk assessments were reviewed and updated if patients had a change in phase of illness. Risk assessments were generated via the electronic system with compliance of completion and re-assessment monitored through regular audits. A new admission template had recently been introduced which included risk assessments. At the time of the assessment, not all staff were confident in navigating the system to find these. Following the assessment, further support and training was provided to those who needed it. Information relating to risks were also documented on a paper handover document that all staff held on their shift and this, therefore, mitigated any risk of not being able to access the electronic risk assessment. Staff we spoke to felt confident in how to raise concerns regarding deteriorating patients. Staff shared key information to keep patients safe when handing over their care to others through a variety of methods. We observed positive interactions during a morning multi-disciplinary team (MDT) handover, where key information was shared. Discussions were patient focussed, considered external referrals, considered timely clinical responses to patient symptoms and a holistic review of mental wellbeing of patients who were experiencing low mood. Patients awaiting admission to the unit were discussed on a daily basis and the unit aimed to admit within 72 hours. Delays in admissions were monitored against key performance indicators.

Staff working for partner organisations told us they worked very closely with the hospice to support the palliative and end of life needs of patients. Daily and weekly MDT meetings were held to allow for effective triage, communication, and hand-over of patient care. Care and support was planned and organised with people, together with partners and communities in ways to ensure continuity. Staff working at partner organisations told us the shared MDT meetings were very useful for continuity, as it allowed them to follow-up patients’ that they may have seen in the hospital. Systems and processes were in place to allow for effective sharing of information between the different organisations and to ensure continuity of care. There was a strong awareness of the risks to people across their care journeys. Discharge meetings were held three times a week for rapidly deteriorating patients, attended by the hospice and various partner organisations. This enabled them, as a system, to be aware of those patients awaiting discharge, and to ensure they had access to the most appropriate services without causing delays in their care journey. Pharmacy services were shared and a monthly Medicines Management Group meeting was held with representation from the hospice, hospital, and pharmacy. This enabled them to share learning, and also develop systems to improve patient safety and decide on any changes to prescribing practice. There were many shared medicines policies, procedures and guidelines, including anticipatory prescribing and medicines authorisation sheets for administration of medicines in the community. Staff from the local NHS Trust described the working relationship between the Trust and the hospice as: “excellent, the focus was always on what could be improved in patient care and support for families. By working together as closely as we do, we are able to quickly identify any areas where there could be improvement.”

Processes were in place to ensure safety and continuity of care throughout people’s care journey. Systems were integrated which allowed for safer care when people transitioned between services. My care choices records were completed on admission and reviewed regularly. This document could be accessed by primary and secondary care professionals. Within the inpatient unit, care plans were automatically generated within the electronic records system. Care plans were individualised and staff could add comments to ensure that patient's wishes and preferences were centrally documented. Community teams and partner organisations were able to access these records allowing for the continuity of care following discharge. We saw effective collaborative working with system partners. For example, the hospice were piloting working with the local NHS ambulance trust to increase the knowledge and skills of paramedics, and to improve responsiveness of the service supporting the avoidance of hospital admission. Staff kept detailed records of patients’ care and treatment. Records were clear, up to date, stored securely and easily available to all staff providing care. We reviewed 10 inpatient care records which were comprehensive. As the community team and various partner organisations accessed the same system, there were no delays in delivering care. We reviewed the ReSPECT forms for all inpatients and found they were fully completed. However, the patient board within the multi-disciplinary team office did not include patients’ current resuscitation status. This was fed back to managers. Previously, this board was used to inform board round. Since the assessment, amendments were made to give a more accurate reflection of what the board was used for. Policies and processes about safety were aligned with other key partners, in line with national guidance, to support deteriorating patients. All staff knew how to access policies and standard operating procedures.

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.

Patient’s we spoke with felt safe and supported to understand and manage any risks. They felt staff delivered care that enabled them to remain well and independent physically, emotionally and mentally. For example, patients and families reported being supported by the chaplain, welfare services and the complimentary therapies team. Patients told us they felt care was delivered by competent staff and were involved in decisions about their care. One patient reported since their admission, they were able to think clearly, sleep had improved and were eating better.

Managers gave all new staff a full induction and mandatory role-specific training. Staff received and kept up to date with their mandatory training. The mandatory training was comprehensive and tailored to the skill requirement of staff, dependent on their role. At the time of our inspection, the overall mandatory training target of 95% was met. Managers supported staff to develop through yearly, constructive appraisals of their work. As of January 2024, 100% of staff received an appraisal. Staff had the opportunity to discuss training needs with their line manager and were supported to develop their skills and knowledge. The service generally had enough staff to keep patients safe. Leaders at the service told us they used bank staff only who were familiar with the service. Staffing levels were planned in advance and a staffing escalation plan was in place when necessary. Managers told us if they were short staffed, a decision would be made to close beds to ensure patient safety. At the time of our inspection, the overall vacancy rate was 14.8 whole time equivalent. There were 10 vacancies, 2 of which were within clinical services and 8 within non-clinical services. Some staff within the community team felt that there was not enough staff to meet the demand on the service. At night, the hospice team worked collaboratively with the district nursing team who supported each other when short of staff and to hand patients over. The service had enough medical staff to keep patients safe. A consultant was on call during the evenings and weekends and all staff we spoke with knew how to contact them if required. There was medical and senior leadership cover for out of hours. All staff were able to explain how they would seek support out of hours if needed, and were confident in doing so.

Staff were experienced, qualified and had the right skills and knowledge to meet the needs of patients. Competency frameworks supported nurses achieve the necessary skills to be competent and confident practitioners in end-of-life care. They were designed to take into account the skills needed for the role and the standards required in the End-of-Life Core Skills Education and Training Framework. Ward nurses had a period of 6 weeks working supernumerary and were required to complete all mandatory training within this time. Staff had reviews at 3, 6 and 12 months before being signed off. Safety was promoted through recruitment procedures and employment checks. Staff had Disclosure and Barring Service (DBS) checks completed before they could work. DBS checks help employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups. The service had an up-to-date recruitment and selection policy to ensure they were able to recruit the right people with the right skills and attitudes to deliver their strategic objectives. Leaders told us their recruitment and selection processes were designed to be fair and non-discriminatory, with equality of opportunity an integral part of their recruitment and selection processes.

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.